A double-blind single-dose trial was performed on 13 patients with primary open-angle glaucoma. Metoprolol 1%, 2%, and 4% produced a median fall in IOP of 5.6, 5.4, and 6.8 mm Hg, respectively, in the treated eye. The differences in effect between the 1%, 2%, and 4% solutions were not statistically significant. There was no significant fall in IOP in the untreated eyes. There were no significant changes in blood pressure, pulse rate, or pupillary diameter. We could not detect any local objective or subjective side effects during the single-dose study. The clinical usefulness of metoprolol may be limited due to local toxic reactions after treatment with multiple doses. Furthermore, there is the problem of tachyphylaxis that could limit extended treatment with topical beta-adrenergic blocking drugs.
SUMMARY During a 7-month period 33 patients (20 with primary open-angle glaucoma and 13 with suspected glaucoma) were treated with guanethidine 3 % and adrenaline 0 5 % in 1 eyedrop twice daily. The previous therapy was discontinued and the aim of the trial was to treat the patients with GA alone. There was an average decrease in intraocular pressure of 10-8 mmHg or 37-5 % for the whole group (including 5 patients with additional therapy). In eyes with an average IOP in a day-curve without medication equal to or higher than 28 mmHg we found a decrease in IOP of 44-6 % or 14-4 mmHg, and in eyes with an average IOP without medication between 21 and 28 mmHg a decrease of 30-4% or 7-6 mmHg. With GA alone the IOP was 3-3 to 3.9 mmHg lower than on the previous therapy (P <0-05); 46 % of the eyes without additional therapy had all IOPs lower than 22 mmHg and 74% of the eyes had TOPs lower than 22 mmHg except 1 with a peak lower or equal to 25 mmHg 3 hours after application. This peak 3 hours after application indicates that GA has a biphasic action and was significant at the 0 50% level.Red eyes and slight ptosis were no problem for most patients. Patients found it very convenient to administer GA only twice daily.During the last 10 years non-miotic therapy has taken a more important place in the treatment of glaucoma patients suspected of having glaucoma and primary open-angle glaucoma (POAG). One of the non-miotic preparations used is a combination of guanethidine and adrenaline. Stepanik (1961), Kutschera (1961), Kuchle (1961), Oosterhuis (1962), and Bonomi and di Comite (1967) reported a fall in intraocular pressure (IOP) with guanethidine 10% alone in the treatment of patients with POAG. This fall was only temporary. Sears (1966) showed in studies on patients with Horner's syndrome 'that the outflow mechanism can be made supersensitive to topical epinephrine'. G. D. and G. Paterson (1972Paterson ( , 1974 pointed to the phenomenon of hypersensitivity of the receptor for sympathomimetic drugs during chemical denervation with guanethidine and to the necessity of applying adrenaline twice daily during the treatment with guanethidine. Longterm studies on guanethidine and adrenaline in patients with glaucoma have been done by Roth (1973), Ftienne (1973), Crombie (1974 The aim of the trial reported here was to investigate the possibility of stopping all previous therapy of patients known to have POAG or suspected of having glaucoma, to treat them only with guanethidine 3% and adrenaline 0 5% (GA) in 1 eyedrop, and to investigate the proper dosage of GA. New patients with POAG or new glaucoma suspects were, if possible, treated only with GA. Thus we obtained an impression of the efficacy of GA alone and its effect in relation to previous therapy.
Patients and methodsThirty-three patients (23 male and 10 female) with either POAG or suspected glaucoma were admitted to the trial. They were divided into 20 patients with POAG (33 eyes, 2 eyes having been previously operated on) and 13 glaucoma suspects (26 eyes).The mean age o...
In order to determine risk factors in corneal transplantations, corneal transplants performed at the Amsterdam Academic Medical Centre (AMC) were registered and the results evaluated by descriptive statistics and actuarial survival curves. The results showed that the diagnosis prior to transplantation, the number of previous transplants, and the vascularization were important prognostic factors for graft survival. The best results were obtained in the absence of vascularization, in primary transplants and in keratoconus, while vascularization in one or more quadrants and a diagnosis such as herpes resulted in poor graft survival. When, for instance, the negative influences of vascularization can be overcome, better results will be obtained.
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