SUMMARY Data for the first 12 months are reported for an ongoing, multicentre, clinical study comparing the long-term, ocular hypotensive efficacy and safety of topical levobunolol (0.5% and 1%) and timolol (0.5%). This study was a double-masked trial testing 88 patientswith chronic open angle glaucoma or ocular hypertension. During the 12-month period drops were instilled twice daily into both eyes after a washout of prestudy ocular hypotensive medication. The effect of the three treatments in reducing intraocular pressure (IOP) was similar. Mean IOP reductions over the 12 months averaged 7*2 mmHg for the 0*5 % levobunolol group, 6-2 mmHg for the 1% levobunolol group, and 6.0 mmHg for the timolol group. Decreases in mean heart rate of up to 5 beats per minute were observed in the 0-5% levobunolol group, up to 8 beats per minute in the 1% levobunolol group, and up to 4 beats per minute in the timolol group. Several patients were removed from the study owing to side effects possibly related to levobunolol treatment.Several short-term studies conducted to investigate the ocular hypotensive effect of various concentrations of topical levobunolol, a non-cardioselective beta-adrenergic blocking agent, have indicated that a maximal pressure reducing effect occurs with the 0-5% and 1% concentrations.'2 Further comparison testing with the levobunolol vehicle over a threemonth time period has confirmed the sustained ocular hypotensive effect produced by these two concentrations of levobunolol over a longer time period.3Because of the progressive nature of glaucoma and the possibility of long-term drift occurring with continued use of topical beta-adrenergic blocking agents45 it is particularly important to assess longterm drug effect when evaluating these drugs. Therefore the present study, a parallel, double-masked clinical trial, was designed to test the efficacy and safety of 0-5% and 1% levobunolol compared with 0-5% timolol in patients with chronic open-angle glaucoma (COAG) or ocular hypertension (OHT) for a period of one year. As most of the patients participating in the study had successfully controlled Correspondence to
45 patients with ocular hypertension or open-angle glaucoma were tested to see if, and to what extent timolol and three other different parasympathicomimetics (pilocarpine 2%, carbachol 1.5%, aceclydine 2%) produced an supplementary reduction of the intraocular pressure. An equally marked, additional drop in eye pressure was achieved when patients who had been given timolol over an extended period of time, were additionally treated with one dose of pilocarpine 2% or carbachol 1.5%. Aceclydine 2% produced no statistically significant additional effect. Patients who had only been treated with pilocarpine 2% over an extended period of time and then were given one dose of timolol 0.25% produced a drop in eye presure more than double that of those patients who had been primarily treated with timolol and then received pilocarpine or carbachol. These results will be discussed on the basis of the mode of action of the applied medications.
A fixed combination of pilocarpine 2% and metipranolol 0.1% was found to have a better pressure-lowering effect than pilocarpine 2% alone or metipranolol 0.1% alone, as well as being tolerated well, both subjectively and objectively. In many cases only the fixed combination was successful in lowering intraocular pressure to tolerable values.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.