The Additive Effect of Dorzolamide Hydrochloride 2% to Bimatoprost 0,03% on Intraocular Pressure and Retrobulbar Blood Flow in Patients with Primary Open-Angle Glaucoma.
Résumé
Aims: To assess the additive effect of dorzolamide hydrochloride 2% on the diurnal intraocular pressure (IOP) curve and retrobulbar hemodynamics in primary open-angle glaucoma (POAG) patients treated with morning-dosed bimatoprost 0.03%. Methods: Twenty five POAG patients, previously treated with any prostaglandin analogs, were evaluated in an prospective, single-masked study. After a week of run-in period with bimatoprost all patients were treated with bimatoprost dosed once in the morning for 1 month, after which dorzolamide was added twice daily for 2 months. Goldmann applanation IOP, arterial blood pressure (ABP) and heart rate were measured every 2 hours for 24 hours and diurnal ocular perfusion pressure (OPP) was calculated. Color Doppler Imaging (CDI) of the ophthalmic (OA) and central retinal arteries (CRA) was recorded five times daily. All measurements were taken after two phases of treatment and compared. Results.The mean baseline IOP was 14.8 ± 3.5 mmHg. Mean IOP, following bimatoprost monotherapy (12.8 ± 2.9 mmHg) and after two months of dorzolamide adjunctive therapy (12.2 ± 2.6 mmHg) were not statistically significant (p=0.544). Only at the 4 AM timepoint IOP was significantly reduced using the bimatoprost/dorzolamide combined therapy (p=0.013). The 24-hour IOP fluctuations were lower when dorzolamide was added (6.0 ± 2.3 mmHg vs. 4.6 ± 1.5 mmHg, p=0.0016). Repeated ANOVA analysis detected a significant decrease of vascular resistance in the OA(p=0.0167) with adjunctive dorzolamide treatment. Conclusions.The addition of dorzolamide to morning-dosed bimatoprost had an additive hypotensive effect only on the nighttime IOP curve at 4 AM and resulted in a lower IOP fluctuation. Dorzolamide added to bimatoprost may reduce vascular resistance in the OA.
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