Traitement des glaucomes par les inhibiteurs de l'anhydrase carbonique en collyre: expérience rétrospective à moyen terme du dorzolamide

Clinical evaluation of the efficacy and innocuity of dorzolamide, the first new born topical carbonic anhydrase inhibitor. Our retrospective analysis included 162 patients (76 men, 86 women) who were exclusively followed in our department and treated between June 96 and August 97 with dorzolamide (Trusopt 2%) administered in a minority of patients (n = 13) as the only hypotensive medication and in combination with other hypotensive drugs and/or as a substitute for acetazolamide or for miotics in the others (add on, n = 149). The mean age of the patients was 65.2 +/- 15.6 and the average follow up was 9.8 +/- 5.4 months. Dorzolamide was prescribed in various forms of glaucoma and ocular hypertension, mostly in POAG (n = 137). In bilateral treatments (n = 116/162), the eye with the most severe defect and/or the highest IOP was considered. IOP was checked along the other criteria generally followed in glaucoma patients at 1 and 3 months following the instauration of dorzolamide and then trimestrially. We considered as the initial IOP a mean value of the 2 most recent successive IOP values before instauration of dorzolamide realized at the same daytime. Patients with laser trabeculoplasty or cataract surgery during the dorzolamide treatment were disguarded. All patients considered, the mean IOP reduction was from 21.5 mm Hg before to 19.3 mm Hg with dorzolamide at the last control. The mean IOP decrease was statistically significant and stable at all controls. The mean IOP reduction was 18.4% (4.2 mm Hg) in the monotherapy group and 12.5% (3 mm Hg) in the add on group. There were 15.3% non responders (mean IOP reduction < half of the average IOP decrease observed all patients confounded) in the monotherapy group and 26% in the add on group. Local tolerance of dorzolamide was excellent in 84%. About 15% of patients (25/162) complained of systemic side effects mostly comparable to the side effects of oral IAC. Treatment was stopped in 57 patients (35.2%) primarily due to allergic blepharoconjunctivitis (n = 12 or 7.4%), general intolerance (n = 14 or 8.6%) and insufficient IOP reduction (n = 26 or 16%). Dorzolamide represents in our experience an effective ocular hypotensive drug but its systemic tolerance profile seems less promising than described in the literature