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Impressum
Ophthalmic artery hemodynamics in primary open angle glaucoma patients on timolol and dorzolamide
Schmidt K.-G., Klingmüller V., Pillunat L. E.
Engadine Hospital, St Moritz, CH; Universities of Oxford, UK; Gießen and Hamburg, Germany.
Purpose: Evidence suggests that ocular hemodynamics influence
prognosis of primary open angle glaucoma (POAG). This study was designed
to determine the influence of 2 topical antiglaucomatous agents on ophthalmic
artery (OA) hemodynamics in POAG patients.
Methods: The influence of timolol (0.5%), a non-selective ß-blocker
and dorzolamide, a topical carbonic anhydrase inhibitor in standard dosage
(BID, 1 eye) on intraocular pressure (IOP), OA hemodynamics (9 MHz linear
and phased array scanners, Elegra Advanced System, Siemens, Germany, transmission
energy reduced to 40%, B-, C-, & triplex-modes), and systemic perfusion
parameters was investigated in 14 POAG patients. Measurements were taken
before, 4 weeks after application of timolol alone, and following another
4 weeks of timolol and dorzolamide treatment.
Results: Values represent mean ± SD. Timolol significantly
(p< 0.0001) reduced IOP (mmHg) in drug treated POAG eyes from 25.2
± 1.5 to 19.8 ± 1.8 (-21.4%) and was significantly (p<
0.0005) additionally reduced to 16.9 ± 1.9 (-14.7%) by combined
therapy. When compared to pretreatment values OA perfusion parameters
(peak systolic velocity: 30.8 ± 2.3 cm/s; enddiastolic velocity:
6.4 ± 1.4 cm/s, resistance (0.79 ± 0.04) and pulsatility
(1.21 ± 0.18) indexes were not (p> 0.05) altered following application
of timolol, whereas dorzolamide significantly increased peak systolic
(32.9 ± 2.9 cm/s; p< 0.03) and enddiastolic (10.8 ± 2.1
cm/s; p< 0.0001) velocities and decreased resistance (0.69 ±
0.05; p< 0.0001) and pulsatility (0.97 ± 0.23; p< 0.003)
indexes. Systemic perfusion parameters were unaltered (p> 0.05).
Conclusion: Combined timolol and dorzolamide therapy reduced IOP
by > 35%, which helps to achieve individual target IOP. Dorzolamide
improved OA hemodynamics in POAG patients, which may decrease progression
in this group of diseases.