Lowering of IOP by echothiophate iodide in pseudophakic eyes with glaucoma.

Abstract

PURPOSE:

We retrospectively investigated the intraocular pressure (IOP)-lowering effects of echothiophate iodide (EI) as adjunctive treatment for pseudophakic glaucoma patients who were receiving maximal medical therapy (MMT), including the newer class of medications, i.e., prostaglandin analogs, alpha-2 agonists, and topical carbonic anhydrase inhibitors.

METHODS:

The medical records of all pseudophakic glaucoma patients (24 eyes) under MMT who received supplementary EI 0.125% between January 2002 and December 2003 were reviewed. IOP data and number of medications before, during and after EI treatment were collected.

RESULTS:

Adding EI to MMT further reduced IOP in 23 of 24 eyes. Three eyes (12.5%) showed some lowering of IOP, but not enough to be considered controlled (IOP above the target pressure). The mean baseline IOP of 30.4 +/- 8.2 mmHg (median 29 mmHg) dropped at final follow-up (11.2 +/- 3.9 months) to 16.6 +/- 4.2 mmHg (median 17 mmHg, p < 0.0001) in all eyes that had showed effective pressure reduction upon the addition of EI. Their IOP rose to 27.7 +/- 8.0 mmHg (median 28 mmHg, p < 0.001) when EI was discontinued because of commercial non-availability. IOP reduction was > or =20% in 18 (75%) eyes and > or =30% (a mean decrease of 16.7 +/- 8.3mmHg) in 15 eyes (63%). Four eyes (16.6%) required a trabeculectomy despite EI supplement. Five eyes were re-challenged with EI when a small amount was released for sale: their IOP of 26.6 +/- 7.1 mmHg after the first EI discontinuation had dropped to 16.4 +/- 4.3 mmHg (p < 0.0001) and rose to 29.6 +/- 7.1 mmHg when EI was again discontinued. The recorded EI-associated side effects were increased miosis in all eyes and headache (8/24 patients), neither of which were reasons for discontinuation of the drug in any patient.

CONCLUSION:

EI substantially decreased the IOPs in pseudophakic glaucoma eyes receiving maximal medical therapy, including the newer class of medications. This drug may be the last resort for post-cataract advanced glaucoma patients and may obviate the need for filtering surgery among the very elderly.

• Authors: K G Schmidt, Yosefa Horowitz, Gila Buckman, Eitan Segev, Elia Levinger, Orna Geyer
• Journal: Current eye research (Curr Eye Res) Vol. 35 Issue 8 Pg. 698-702 (Aug 2010) ISSN: 1460-2202 [Electronic] England
• PMID: 20673046 (Publication Type: Journal Article)

Chemical References

• Antihypertensive Agents
• Cholinesterase Inhibitors
• Echothiophate Iodide

Topics

• Aged
• Antihypertensive Agents (therapeutic use)
• Cholinesterase Inhibitors (therapeutic use)
• Drug Therapy, Combination
• Echothiophate Iodide (therapeutic use)
• Female
• Glaucoma, Open-Angle (drug therapy, etiology)
• Humans
• Intraocular Pressure (drug effects)
• Male
• Pseudophakia (complications)
• Retrospective Studies
• Tonometry, Ocular
• Trabeculectomy