Abstract
The reason for the poorer prognosis of pseudoexfoliation syndrome glaucomas (PXSG) compared with primary open angle glaucomas (POAG) is not fully understood. An open, comparative, cross-over study was performed in 15 patients (= eyes) with POAG and 15 patients (= eyes) with PXSG. Two different pharmacokinetic principles of drug administration were applied to uncover possible differences in short-term (hours) response to topical anti-glaucomatous treatment. Intermittent pilocarpine drop medication (2%) and continuous low-dose pilocarpine delivery by a membrane-controlled Ocusert unit (P40) were used. The ‘carry-over’ pressure reduction of an ordinary four times a day drop medication was significantly less effective in controlling the morning intraocular pressure (9 a.m.) in PXSG than in POAG. The duration of action of pilocarpine drops was reduced in PXSG. Defining ‘normotensive’ pressure as ≤20 mmHg, only 1 of the 15 PXSG eyes (6.7%) reached a normoten-sive level in the morning, compared with 8 of the 15 POAG eyes (53.3%). Using a continuous supply of pilocarpine (Ocusert), no differences between POAG and PXSG eyes were found. The study demonstrates the insufficient control of intraocular pressure in PXSG, compared with POAG, by identical antiglaucomatous drop medications. This may suggest an insufficient depot function of topical drugs in PXSG. In consequence, pseudoexfoliation material (PXM) must be sought in eyes with glaucoma, as PXM eyes will probably benefit from a more intense medical treatment compared with eyes without PXM.
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References
Tarkkanen A . Treatment of chronic open-angle glaucoma associated with pseudoexfoliation. Acta Ophthalmol (Copenh) 1965;43:514–23.
Hørven I . Exfoliation syndrome: incidence and prognosis of glaucoma capsulare in Massachusetts. Arch Ophthalmol 1966;76:505–ll.
Klouman OF . Pseudoexfoliation in ophthalmic practice. Acta Ophthalmol (Copenh) 1967;45:822–8.
Aasved H . The frequency of optic nerve damage and surgical treatment in chronic simple glaucoma and capsular glaucoma. Acta Ophthalmol (Copenh) 1971;49:489–600.
Lay den WE, Shaffer RN . Exfoliation syndrome. Am J Ophthalmol 1974;78:835–41.
Olivius E, Thorburn W . Prognosis of glaucoma simplex and glaucoma capsulare: a comparative study. Acta Ophthalmol (Copenh) 1978;56:921–34.
Brooks AMV, Gillies WE . The presentation and prognosis of glaucoma in pseudoexfoliation of the lens capsule. Ophthalmology 1988;95:271–6.
Hansen E, Sellevoid OJ . Pseudoexfoliation of the lens capsule. III. Ocular tension in eyes with pseudoexfoliation. Acta Ophthalmol (Copenh) 1970;48:446–54.
Aasved H . Intraocular pressure in eyes with and without fibrillopathia epitheliocapsularis (so-called senile exfoliation or pseudoexfoliation). Acta Ophthalmol (Copenh) 1971;49:601–10.
Bedikt O, Roll P . The trabecular mesh work of a non-glaucomatous eye with the exfoliation syndrome. Virchows Arch [A] 1979;384:347–55.
Pohjanpelto P . Argon laser treatment of the anterior chamber angle for increased intraocular pressure. Acta Ophthalmol (Copenh) 1981;59:211–5.
Ritch R, Podos SM . Laser trabeculoplasty in the exfoliation syndrome. Bull NY Acad Med 1983;59:339–44.
Tuulonen A, Airaksinen PJ . Laser trabeculoplasty in simple and capsular glaucoma. Acta Ophthalmol (Copenh) 1983;61:1009–15.
Kerty E, Hørven I . Glaucoma treatment with timolol. Acta Ophthalmol (Copenh) 1978;56:705–13.
Airaksinen PJ . The long-term hypotensive effect of timolol maleate compared with the effect of pilocarpine in simple and capsular glaucoma. Acta Ophthalmol (Copenh) 1979;57:425–34.
Aasved H, Seland JH, Slagsvold JE . Timolol maleate in treatment of open-angle glaucoma. Acta Ophthalmol (Copenh) 1979;57:700–8.
Blika S, Saunte E . Timolol maleate in the treatment of glaucoma simplex and glaucoma capsulare. Acta Ophthalmol (Copenh) 1982;60:967–76.
Armaly MF, Rao K . The effect of pilocarpine Ocusert on ocular pressure. In: Leopold IH, editor. Symposium of ocular therapy. Vol. 6. St. Louis: Mosby, 1973:80–94.
Davanger M . The pressure reducing effect of miotics in glaucoma simplex and in normal eyes, elucidated by hydrodynamic calculations based on Poiseuille's law. Acta Ophthalmol (Copenh) 1964;42:773–81.
Krill AE, Newell FW . Effects of pilocarpine on ocular tension dynamics. Am J Ophthalmol 1964;57:34–41.
Brinchmann-Hansen O, Anmarkrud N . Pilocarpine medication in open-angle glaucoma. Acta Ophthalmol (Copenh) 1979;57:55–62.
Kolker AE, Hetherington J Jr. Clinical interpretation of gonioscopic findings. In: Becker-Schaffer's diagnosis and therapy of the glaucomas. 4th ed. St. Louis: Mosby, 1976:42–53.
Drance SM, Bensted M, Schulzer M . Pilocarpine and intraocular pressure. Arch Ophthalmol (Copenh) 1974;91:104–6.
Asseff CF, Weisman RL, Podos SM, Becker B . Ocular penetration of pilocarpine in primates. Am J Ophthalmol 1973;75:212–5.
Sendelbeck L, Moore D, Urquhart J . Comparative distribution of pilocarpine in ocular tissues of the rabbit during administration by eyedrop or by membrane-controlled delivery systems. Am J Ophthalmol 1975;80:274–83.
Havener WH . Autonomic drugs. In: Ocular pharmacology. 4th ed. St. Louis: Mosby, 1978:267–87.
Shell JW . The pharmacokinetics of topical glaucoma medications. In: Drance SM, Neufeld AH, editors. Glaucoma: applied pharmacology in medical treatment. New York: Grune & Stratton, 1984:185–213.
Melikian HE, Lieberman TW, Leopold IH . Ocular pigmentation and pressure and outflow responses to pilocarpine and epinephrine. Am J Ophthalmol 1971;72:70–3.
Harris LS, Galin MA . Effect of ocular pigmentation on hypotensive response to pilocarpine. Am J Ophthalmol 1971;72:923–5.
Lyons JS, Krohn DL . Pilocarpine uptake by pigmented uveal tissue. Am J Ophthalmol 1973;75:885–8.
Salminen L, Imre G, Huupponen R . The effect of ocular pigmentation on intraocular pressure response to timolol. Acta Ophthalmol (Copenh) 1985;63 (Suppl 173):15–8.
Abrahamsson T, Bostrøm S, Brautigam J, Lagerstrøm PO, Regårdh CG, Vauqelin G . Binding of the beta-blockers timolol and H 216/44 to ocular melanin. Exp Eye Res 1988;47:565–77.
Alm A, Bill A, Young FA . The effects of pilocarpine and neostigmine on the blood flow through the anterior uvea in monkeys: a study with radioactively labelled microspheres. Exp Eye Res 1973;15:31–6.
Green K, Hatchett TL . Regional ocular blood flow after chronic topical glaucoma drug treatment. Acta Ophthalmol (Copenh) 1987;65:503–6.
Davanger M, Ringvold A, Blika S . Pseudo-exfoliation, IOP and glaucoma. Acta Ophthalmol (Copenh) 1991;69:569–73.
Zeimer RC, Wilensky JT, Gieser DK, Viana MAG . Association between intraocular pressure peaks and progression of visual field loss. Ophthalmology 1991;98:64–9.
Birchely A, Mudie P, Brown B . IOP elevation in different phases of sleep. Clin Exp Optom 1990;73:93–6.
Wildsoet CF, Brown B, Swann PG . Darkness and sleep as contributing factors to diurnal variation in intraocular pressure. Glaucoma 1990;12:140–7.
Zeimer RC, Wilensky JT, Gieser DK . Presence and rapid decline of early morning intraocular pressure peaks in glaucoma patients. Ophthalmology 1990;97:547–50.
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Brinchmann-Hansen, O., Albrektsen, T. & Anmarkrud, N. Pilocarpine drops do not reduce intraocular pressure sufficiently in pseudoexfoliation glaucoma. Eye 7, 511–516 (1993). https://doi.org/10.1038/eye.1993.111
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DOI: https://doi.org/10.1038/eye.1993.111