Efficacy of dorzolamide in improving ocular blood flow in patients with open-angle glaucoma: The Indian carbonic anhydrase inhibitor trial

Abstract

Purpose: Impaired ocular blood flow is an important risk factor in the pathogenesis of open-angle glaucoma (OAG). Studies have reported that dorzolamide 2% may be effective in improving ocular blood flow (OBF) in OAG patients. The objective of this study was to determine the efficacy of dorzolamide 2% (DORZOX, Cipla Ltd.) in improving retrobulbar blood flow in an Indian setting. Methods: The study was conducted as an interventional pilot project in 24 healthy subjects and 19 OAG patients. Baseline OBF measurements were done for all glaucoma patients with color Doppler imaging (CDI). Baseline ocular perfusion pressure (OPP) was calculated for all participants. Glaucoma patients were given dorzolamide 2% thrice daily for 12 weeks. The primary efficacy endpoints were mean changes in the CDI parameters of the retrobulbar vessels and OPP posttreatment. The secondary endpoint was mean change in the intraocular pressure (IOP) and adverse events, if any. Results: In comparison to healthy subjects, glaucoma patients displayed significantly reduced baseline OPP ( P = 0.002). Treatment with dorzolamide 2% for 12 weeks led to a significant increase in OPP ( P < 0.001) and a significant increase in end diastolic velocity (EDV) in all major ophthalmic arteries like ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA) ( P < 0.001, P = 0.04, and P = 0.0075, respectively). A significant reduction in the intraocular pressure (IOP; P = 0.007) was observed posttreatment, with no adverse events reported. Conclusion: Dorzolamide 2% significantly improved parameters such as the EDV and OPP in major ophthalmic arteries. This pilot study shows promising results on using dorzolamide for treating Indian patients with OAG.

Prescription of glucagon-like peptide 1 agonists and risk of subsequent open-angle glaucoma in individuals with type 2 diabetes mellitus

“…Although intraocular pressure is a crucial risk factor for OAG [30], the impairment of ocular vasculature has recently been recognized as another major factor contributing to OAG development [31]. In individuals with OAG, ocular blood flow decreases and can be reversed by dorzolamide [32]. Additionally, the vascular densities of the optic disc and macula are significantly lower in individuals with OAG [33,34].…”

“…Finally, the exclusion and matching process resulted in the loss of approximately 40% of individuals with GLP-1RA application. Although this was done to enhance diagnostic accuracy and homogeneity, the impact of patient loss might not be significant as the GLP-1RA group still included over 1000 patients, a number not inferior to previous studies [32,34].…”

Measurement of Retrobulbar Blood Flow and Vascular Reactivity—Relevance for Ocular and Cardiovascular Diseases

“…However, other studies have found an increase in RI values of the SPCAs after topical application of timolol and a significant decrease in RI in the CRA and SPCA after the application of betaxolol, indicating varying vasodilatory effects of different beta blockers [66]. Treatment with dorzolamid 2%, a carbonic anhydrase inhibitor, improved ocular perfusion pressure and lead to an increase in EDV in major OAs [67]. No retrobulbar hemodynamic changes were found after therapy with latanoprost, brimonidine, or latanoprost and timolol or brimonidine and timolol fixed combinations [68,69].…”

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