Br J OphthalmolAugust 202136 citations

Topical carbonic anhydrase inhibitors and glaucoma in 2021: where do we stand?

Stoner Ari, Harris Alon, Oddone Francesco, Belamkar Aditya, Verticchio Vercellin Alice Chandra, Shin Joshua, Januleviciene Ingrida, Siesky Brent

View on PubMed DOI: 10.1136/bjophthalmol-2021-319530

AI Summary

This review examined topical CAIs for glaucoma, finding they remain valuable combination therapy, potentially influencing ocular hemodynamics beyond pressure reduction, despite less frequent primary use.

Abstract

Carbonic anhydrase inhibitors (CAIs) have been used for many decades in the treatment of glaucoma. Systemic CAIs were an early treatment option to lower intraocular pressure by reducing aqueous humour production; however, frequent side effects including polyuria and paresthesia contributed to the eventual development of topical CAIs. As topical drug development evolved over time, prostaglandin analogues and beta-blockers have become the gold standard of glaucoma therapies. Although prescribed less often than other classes of topical glaucoma therapies, topical CAIs continue to be used in combination therapies with beta-blockers and alpha agonists. Topical CAIs have also been demonstrated to alter biomarkers of ocular haemodynamics, which have relevance in glaucoma. The purpose of this review is to review and summarise the current state of topical CAI prescribing trends, known efficacy and suggested mechanisms and potential influence on ocular haemodynamics for the future of glaucoma management.

MeSH Terms

Administration, TopicalAdrenergic beta-AntagonistsAqueous HumorCarbonic Anhydrase InhibitorsGlaucomaHumansIntraocular PressureTonometry, Ocular

Shields Classification

Ch. 28Principles of Medical Therapy for Glaucoma

Ch. 31Adrenergic Stimulators

Key Concepts4

Topical carbonic anhydrase inhibitors (CAIs) continue to be used in combination therapies with beta-blockers and alpha agonists, despite prostaglandin analogues and beta-blockers becoming the gold standard of glaucoma therapies.

TreatmentReviewn=Not applicableCh29Ch31Ch33

Topical carbonic anhydrase inhibitors (CAIs) have been demonstrated to alter biomarkers of ocular haemodynamics, which are relevant in glaucoma.

MechanismReviewn=Not applicableCh33

Carbonic anhydrase inhibitors (CAIs) have been used for many decades in the treatment of glaucoma.

TreatmentReviewn=Not applicableCh33

Systemic carbonic anhydrase inhibitors (CAIs) were an early treatment option to lower intraocular pressure by reducing aqueous humour production, but frequent side effects including polyuria and paresthesia led to the development of topical CAIs.