J Korean Ophthalmol Soc.  1974 Mar;15(1):83-89.

Medical Treatment of the Glaucoma

• Youn DH

Abstract

The goal of treatment in open-angle glaucoma is to prevent loss of visual function. If we prevent loss of function, our treatment is adequate. Our all treatment is designed to lower the pressure, either by increasing the facility of outflow or by suppressing formation of aqueous humor, or both. The drugs which used in medical treatment were listed. The steps in medical management were reviewed. Pilocarpine is our first and favorite drug(1-4%). A different approach, using epinephrine first may be indicated in certain young and myopic patients and in patients having axial lens opacities. Epinephrine 1 to 2% is added to the miotic treatment if tension remains not satisfactorily controlled. It is used 1 to 3 times a day. If 4% pilocarpine or its equivaleht plus epinephrine fail to bring about satisfactory lowering of tension, one of the stronger miotics can be substituted or added. The next step is the addition of carbonic anhydrase inhibitors orally, starting with acetazolamide 125mg 2 or 3 times a day, or its equivalent in some other drug. If more is necessary, and if the drug is tolerated. 1 gram a day, or its equivalent in some other drug is given in divided doses. Only when one is using 4% pilocarpine or its equivalent every 2 to 4 hours, epinephrine 1 to 3 times a day. with one of the stronger miotics added to the program or substituted for the weaker miotic. plus a carbonic anhydrase inhibitor to tolerance can one fed that maximum medical treatment is being employed. One can not speak of the failure of medical treatment and the necessity of operation unless the maximum tolerated medical treatment has been employed. and the tension is still not adequately controlled. Treatment depends on several factors, the most important of which are the height of the intraocular pressure; the age, health and life expectancy of the patient; the degree of disc and field damage; a family history of serious glaucoma; and the production of symptoms from use of antiglaucoma drugs. Medical treatment in angle-closure glaucoma was described. The medical therapy for angle-closure glaucoma is useful only as a prelude to surgery. Glycerol, Diamox, and pilocarpine may be used simultaneously to obtain prompt normalization of pressure. If the iris is not pulled away from the meshwork, peripheral anterior synechias may become permanent in a few hours. When pressure has become normalized, it is of utmost importance that the eye should be operated on promptly.

MeSH Terms

Acetazolamide
Aqueous Humor
Carbonic Anhydrase Inhibitors
Carbonic Anhydrases
Cataract
Epinephrine
Glaucoma*
Glaucoma, Angle-Closure
Glaucoma, Open-Angle
Glycerol
Humans
Intraocular Pressure
Iris
Life Expectancy
Miotics
Pilocarpine
Acetazolamide
Carbonic Anhydrase Inhibitors
Carbonic Anhydrases
Epinephrine
Glycerol
Miotics
Pilocarpine