Ординатура / Офтальмология / Английские материалы / Glaucoma Medical Therapy Principles and Management_Netland_2008

This page intentionally left blank

Acknowledgments

his book was a team effort, and I am indebted to the contributors to this Tmonograph for giving so generously of their time and expertise. I am also grateful to the reviewers for this book, who, despite their anonymity, provided important peer review of this material. The Foundation of the American

Academy of Ophthalmology and the Clinical Education Staff provided skilled assistance for the first edition of this book, particularly Pearl C. Vapnek, managing editor of the Ophthalmology Monographs series. In developing the first edition, help and encouragement were afforded by the Ophthalmology Monographs Committee, including Drs. H.S. Eustis, A. Capone, W.W. Culbertson, J.C. Fleming, C.L. Karp, B.G. Haik, and M.A. Johnstone. Clinical Education Secretaries provided valuable guidance for the first and second editions, including Drs. T.A. Weingeist, M.A. Kass, T. Liesegang, and G.L. Skuta. Dr. Richard K. Parrish, II, the series editor, has provided important oversight for the monograph series, including the second edition of this book. I am especially thankful for the expert assistance of Mary E. Smith, MPH, RDMS, project manager for the book at the University of Tennessee. The team at Oxford University Press provided excellent publishing support for the second edition, including editorial assistant Nicholas C. Liu, production editor Brian Desmond, marketing manager John Hercel, and sales manager Marnie Vandenberg. I am especially indebted to Catharine Carlin, editor at Oxford University Press, for her support and encouragement throughout the development of the second edition of this book.

I am most grateful for the memory of my co-editor for the first edition of Glaucoma Medical Therapy, Dr. Robert C. Allen. Book coauthors usually have a unique bond, but our relationship surpassed even that closeness. I will miss Bob’s advice, support, and friendship.

This page intentionally left blank

Contents

Contributors, xxi

1.Ocular Pharmacology, 3

Simon K. Law and David A. Lee

1.1Bioavailability in Ocular Compartments, 4

1.1.1Drug Transfer Rate and Concentration, 5

1.1.2Drug Absorption, 5

1.2Aqueous Humor Dynamics, 9

1.2.1Theories of Production, 9

1.2.2Rate of Production, 10

1.2.3Aqueous Outflow, 10

1.3Tear Film Dynamics, 10

1.4Drug Formulation, 11

1.4.1Solution Versus Suspension, 11

1.4.2Buffering and pH, 12

1.4.3Osmolality and Tonicity, 12

1.4.4Viscosity, 13

1.4.5Preservatives, 13

1.4.6Drug Delivery by Prodrugs, 14

1.5New Drug Delivery Vehicles, 14

1.5.1Emulsions, 14

1.5.2Gels, 15

1.6Drug Delivery Systems, 15

1.6.1Ocusert, 16

xivContents

1.6.2Liposomes, 17

1.6.3Slow-Release Contact Lenses, 21

1.6.4Implantable Reservoirs, 22

1.7Ocular Use of Steroids, 24

1.7.1Pharmacology of Steroids, 24

1.7.2Steroids in Ocular Use, 25

1.7.3IOP Response With Steroid Use, 25

2.Prostaglandin Analogs, 33

Thomas W. Hejkal and Carl B. Camras

2.1Mechanism of Action, 34

2.2Indications, 35

2.3Contraindications, 36

2.4Treatment Regimen, 36

2.5Side Effects, 37

2.5.1Conjunctival Hyperemia, 37

2.5.2Iris Color Changes, 38

2.5.3Eyelash Changes, 39

2.5.4Uveitis, 39

2.5.5Cystoid Macular Edema, 40

2.5.6Other Local Side Effects, 41

2.5.7No Systemic Side Effects, 41

2.6Drug Interactions, 41

2.7IOP Reduction in Clinical Trials, 42

2.8Clinical Studies on Additivity, 43

2.8.1Beta Blockers, 44

2.8.2Carbonic Anhydrase Inhibitors, 44

2.8.3Cholinergic Agonists, 44

2.8.4Adrenergic Agonists, 45

2.8.4Fixed Combinations With PG Analogs, 45

3.Beta Blockers, 55

Albert S. Khouri, Paul J. Lama, and Robert D. Fechtner

3.1General Pharmacology, 56

3.2Mechanism of Action, 56

3.3Indications, 57

3.4Contraindications, 57

3.5Treatment Regimens, 58

3.6Side Effects, 58

3.6.1Local Adverse Effects, 58

3.6.2Systemic Adverse Effects, 59

3.6.3Central Nervous System Adverse Effects, 60

3.6.4Cardiovascular System Adverse Effects, 60

3.6.5Pulmonary Adverse Effects, 61

3.6.6Metabolic Adverse Effects, 62

3.7Drug–Drug Interactions, 63

Contents xv

3.8Drug–Disease Interactions, 64

3.9Specific Ocular Beta Blockers, 65

3.9.1Nonselective Beta Blockers, 65

3.9.1.1Timolol solution, 65

3.9.1.2Carteolol Hydrochloride 1% (Ocupress), 69

3.9.1.3Levobunolol Hydrochloride (Betagan), 69

3.9.1.4Metipranolol 0.3% (OptiPranolol), 70

3.9.2Selective Beta Blockers, 70

3.9.2.1Betaxolol Hydrochloride, 70

3.9.3Combination Drugs, 70

3.10Conclusion, 70

4.Adrenergic Agents, 79

Elliott M. Kanner and Howard I. Savage

4.1Adrenergic Physiology in the Eye, 79

4.2Pharmacology, 81

4.3Nonselective Agonists, 81

4.3.1Epinephrine, 81

4.3.2Dipivefrin, 82

4.4Alpha-Selective Agonists, 83

4.4.1Clonidine, 83

4.4.2Apraclonidine, 84

4.4.2.1Pharmacology, 84

4.4.2.2Mechanism of Action, 84

4.4.2.3Safety, 86

4.4.2.4Indications, 88

4.4.3Brimonidine, 92

4.4.3.1Pharmacology, 92

4.4.3.2Mechanism of Action, 92

4.4.3.3Efficacy, 92

4.4.3.4Safety, 93

4.4.3.5Indications, 94

4.4.3.6Neuroprotection, 94

4.5Conclusion, 95

5.Cholinergic Drugs, 103

B’Ann True Gabelt and Paul L. Kaufman

5.1Mechanism of Action, 103

5.2Contraindications, 106

5.3Indications and Treatment, 109

5.4Side Effects, 109

5.5Drug Interactions, 113

5.6Results of Clinical Trials, 114

5.7Direct, Short-Acting Drugs, 114

5.7.1Pilocarpine, 115

5.7.1.1Formulations, 115

xviContents

5.7.1.2Pharmacokinetics, Concentration–Effect Relationship, and Metabolism, 115

5.7.2Carbachol, 116

5.7.2.1Formulations, 116

5.7.2.2Pharmacokinetics, Concentration–Effect Relationship, and Metabolism, 117

5.8Indirect, Long-Acting Drugs, 117

5.8.1Echothiophate, 117

5.8.1.1Formulations, 118

5.8.1.2Pharmacokinetics, Concentration-Effect Relationship, and Metabolism, 118

Acknowledgment, 118

6.Carbonic Anhydrase Inhibitors, 123

Eve J. Higginbotham and Robert C. Allen

6.1Systemic Carbonic Anhydrase Inhibitors, 124

6.1.1General Pharmacology, 124

6.1.2Mechanism of Action, 124

6.1.3Indications, 125

6.1.4Contraindications, 126

6.1.5Treatment Regimen, 126

6.1.6Side Effects, 126

6.2Topical Agents, 128

6.2.1Pharmacology, 128

6.2.2Mechanism of Action, 129

6.2.3Indications, 129

6.2.4Dorzolamide, 129

6.2.5Brinzolamide, 134

7.Fixed-Combination Drugs, 139

Albert S. Khouri, Tony Realini, and Robert D. Fechtner

7.1Products of Historical Interest, 140

7.1.1Pilocarpine–Epinephrine, 140

7.1.2Timolol–Pilocarpine and Timolol–Epinephrine, 140

7.1.3Betaxolol–Pilocarpine, 141

7.2Modern Fixed Combination Approved in the United States: Timolol–Dorzolamide, 141

7.3Modern Fixed Combinations Approved Outside the United States, 142

7.3.1Timolol–Latanoprost, 143

7.3.2Timolol–Travoprost, 144

7.3.3Timolol–Bimatoprost, 145

7.3.4Timolol–Brimonidine, 146

7.4Conclusion, 146

8.Osmotic Drugs, 151

Peter A. Netland and Allan E. Kolker

Contents xvii

8.1Mechanism of Action, 152

8.2Indications, 154

8.3Contraindications, 154

8.4Treatment Regimen, 154

8.5Side Effects, 155

8.6Drug Interactions, 158

8.7Clinical Use, 158

8.7.1Angle-Closure Glaucoma, 158

8.7.2Secondary Glaucomas, 158

8.7.3Aqueous Misdirection, 159

8.7.4Perioperative Use, 159

8.8Oral Osmotic Drugs, 159

8.8.1Glycerol, 159

8.8.2Other Oral Osmotic Drugs, 160

8.9Intravenous Osmotic Drugs, 162

8.9.1Mannitol, 162

8.9.2Other Intravenous Osmotic Drugs, 162

9.Systemic Drugs and Intraocular Pressure, 165

Peter A. Netland

9.1Drugs for Systemic Hypertension, 165

9.1.1Beta-Adrenergic Antagonists, 165

9.1.2Central Sympatholytics, 168

9.1.3Calcium Channel Blockers, 169

9.1.4Angiotensin-Converting Enzyme Inhibitors, 171

9.1.5Other Hypertensive Medications, 172

9.2Antiepileptic Drugs, 173

9.3Marijuana, 173

9.4Alcohol, 174

9.5Alternative Medicine, 175

10.Initial Medical Treatment, 179

Nauman R. Imami and R. Rand Allingham

10.1Patient History and Risk Factors, 180

10.2Glaucoma Treatment Trials, 181

10.3To Treat or Not to Treat, 186

10.4Target Intraocular Pressure, 186

10.5Initial Treatment Modality, 190

10.6Initial Medical Management, 191

10.7Patient Follow-up, 193

10.8Glaucoma Suspects, 194

11.Adjunctive Medical Therapy, 201

Malik Y. Kahook, Lisa S. Gamell, and Joel S. Schuman

11.1Adjunctive Therapy: First-Line Drugs, 202

11.2Combination Therapy, 202

xviiiContents

11.3Addition or Substitution?, 203

11.4Additivity of Medications, 203

11.5Progressing to Maximal Medical Therapy: Individualizing Treatment, 204

11.6Improvement of Compliance, 205

11.7Enhancement of Surveillance, 207

11.8High IOP on Initial Presentation, 208

11.9When Medical Therapy Fails, 209

11.10Conclusions, 211

12.Special Therapeutic Situations, 215

Robert Ritch, Yaniv Barkana, and Jeffrey M. Liebmann

12.1Angle-Closure Glaucoma, 215

12.1.1Acute Angle Closure, 216

12.1.2Chronic Angle Closure, 220

12.2Discrete Open-Angle Glaucomas, 221

12.2.1Pigmentary Glaucoma, 222

12.2.2Exfoliation Syndrome, 224

12.2.3Corticosteroid-Induced Glaucoma, 224

12.2.4Neovascular Glaucoma, 225

12.2.5Iridocorneal Endothelial Syndrome, 226

12.3Trauma and Glaucoma, 226

12.3.1Hyphema, 226

12.3.2Angle-Recession Glaucoma, 226

12.3.3Inflammation, 227

12.3.4Foreign Bodies, 227

12.3.5Chemical Burns, 227

12.4Other Special Situations, 228

12.4.1Infants and Children, 228

12.4.2Prepresbyopic Adults, 229

12.4.3Patients with Cataracts, 229

12.4.4Panallergic Patients, 229

Acknowledgment, 230

13.Pregnancy and Pediatric Patients, 233

Elliott M. Kanner and Peter A. Netland

13.1Glaucoma Medical Therapy in Pregnancy, 233

13.1.1General Considerations, 233

13.1.2Natural History of Intraocular Pressure During Pregnancy, 234

13.1.3Teratogenicity, 234

13.1.4FDA Safety Categories, 234

13.2Glaucoma Medical Therapy During Lactation, 234

13.3Glaucoma Medical Therapy in Pediatric Patients, 235

13.3.1General Considerations, 235

13.3.2Specific Drug Classes, 235

13.3.2.1Prostaglandin Analogs, 235

13.3.2.2Beta Blockers, 236

Contents xix

13.3.2.3Carbonic Anhydrase Inhibitors, 237

13.3.2.4Fixed Combinations, 238

13.3.2.5Cholinergic Drugs, 238

13.3.2.6Adrenergic Agonists, 239

13.3.2.7Osmotic Agents, 240

13.4Conclusion, 240

14.Compliance with Ocular Medication, 243

Pouya N. Dayani and Michael A. Kass

14.1Clinical Features of Noncompliance, 244

14.2Prevalence of Noncompliance, 244

14.3Reasons for Noncompliance, 246

14.3.1Patient Factors, 246

14.3.2Disease Factors, 248

14.3.3Treatment Factors, 248

14.3.4Patient–Physician Relationship, 249

14.3.5Clinical Environment, 250

14.4Detection of Noncompliance, 250

14.5Strategies to Improve Compliance, 251

14.5.1Simplification of Regimen, 251

14.5.2Improvement of Patient–Physician Relationship, 252

14.5.3Patient Education, 252

14.5.4Memory Aids, 252

14.6Looking Forward, 253

15.From Medical to Surgical Therapy, 259

Robert N. Weinreb and Felipe A. Medeiros

15.1Maximum Medical Therapy, 260

15.2The Optic Nerve and Target Intraocular Pressure, 261

15.3Neuroprotection, 261

15.4Laser Surgery, 262

15.5Surgical Considerations, 262

15.5.1Nonpenetrating Drainage Surgery, 262

15.5.2Sequence of Laser Surgery and Trabeculectomy, 262

15.6Surgical Contraindications, 263

15.7Concluding Comment, 263

Self-Study Examination, 265

Self-Study Examination Answer Sheet, 266

Index, 281