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ARTICLE
Year : 1965  |  Volume : 13  |  Issue : 4  |  Page : 151-157

Effect of sustained release acetazolamide on the intra-ocular tension in normal and glaucomatous eyes


Dept. of Ophthalmology, Maulana Azad Medical College, New Delhi, India

Date of Web Publication25-Feb-2008

Correspondence Address:
SRK Malik
Dept. of Ophthalmology, Maulana Azad Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Malik S, Sood G C, Bhardwaj P C, Saha S K. Effect of sustained release acetazolamide on the intra-ocular tension in normal and glaucomatous eyes. Indian J Ophthalmol 1965;13:151-7

How to cite this URL:
Malik S, Sood G C, Bhardwaj P C, Saha S K. Effect of sustained release acetazolamide on the intra-ocular tension in normal and glaucomatous eyes. Indian J Ophthalmol [serial online] 1965 [cited 2020 Feb 19];13:151-7. Available from: http://www.ijo.in/text.asp?1965/13/4/151/39261

The carbonic anhydrase inhibitors have been extensively used in Oph­thalmology especially for the treat­ment of glaucoma, flat anterior chamber and pre and post operatively in various forms of intra ocular sur­gery. Acetazolamide is the most popular of the many carbonic anhy­drase inhibitors available due to its minimal side effects such as panes­thesia, gastric irritation and transient myopia etc. However there have been cases in which the side effects were severe enough to reduce or to discontinue its use. Acetazolamide is usually administered in the form of tablets. About 750 to 1000 mgms of the drug are administered in divi­ded doses. Since the drug is rapidly absorbed and excreted, a high dosage is necessary as theraputic levels are not maintained sufficiently long in the blood stream and the intra-ocular pressure tends to rise in between the dosages.

Sustained release acetazolamide differs from the acetazolamide tablets in that there is a regular rate of release of the drug which results in constant clinical levels being main­tained in the blood stream. The mechanism of sustained release is ob­tained by having different quantities of the drug coated by various thick­nesses of the coat, so that different sized granules are available for ab­sorption at different rates. A portion of the-drug is available for immediate release.

The present study was undertaken to evaluate the action of sustained release acetazolamide in the normal and glaucomatous cases.

Methods and Material: The cases were selected from the patients ad­mitted in the Irwin Hospital. The study was divided into three groups.

I Normal eyes (26 eyes of normal patients).

A capsule containing 500 mgm of acetazolamide sustained release was given to this group at about 6 O'clock in the morning and the tension was recorded every hour for 6 hours and every 2 hourly for about 10 hours. No miotics were instilled.

II Glaucomatous cases: (30 eyes of 29 patients) who received sustained release acetazolamide without miotics, as in Group I.

a) Chronic simple glaucoma - 7 eyes.

h) Acute glaucoma - 10 eyes.

Secondary glaucoma - 6 eyes.

Absolute glaucoma - 7 eyes.

HI This group, of glaucomatous eyes (35 eyes of 31 patients), in addi­tion to a capsule of sustained release actazolamide, had instillation of mio­tics in their eyes.

Acute congestive glaucoma 10 eyes.

Chronic simple glaucoma - 15 eyes.

Secondary glaucoma 6 eyes.

Absolute - glaucoma 4 eyes.


  Observations Top


The observations regarding the effects of sustained release acetazolamide alone and with miotics on the ultra ocular pressure are illustrated in graphs 1 to 8.


  Discussion Top


500 mgm of sustained release ace-tazolamide lowered intra ocular tension in all 26 normal eyes studied in this series. The degree of fall of the intra ocular pressure varied from 4-7 mm Hg. The fall of intra ocular tension started an hour after the ad­ministration of the drug. The max­imum fall was noted after 2 to 4 hours which lasted for about 5 to 7 hours. The tension remained low even for 16 hours after the adminis­tration (See graph 1). Kleinerd did not notice any lowering of intra ocular tension in the normal eye after the administration of diamox tablet. Becker (1954) and Agarwal et al (1955) noticed a fall of intra ocular pressure in normal cases but they did not get uniform results. Drance et al (1961) observed the fall of intra ocular tension in all normal eyes in which the sustained release Acetazolamide was given. They noticed that the fall began during the first three hours and was max­imum after 2 hours, and that the tension remained below the initial level even after 24 hours. Our re­sults are comparable to theirs except that in our series the maximum fall was noticed after 2 to 4 hours.

30 eyes of 29 cases of various types of glaucoma were given single dose of sustained release Acetazolamide. No other drug was administered either before or during the day of study. In 28 eyes there was a mark­ed fall of intra ocular pressure vary­ing from 45 to 56%. This pronounced fall of intra ocular pressure lasted for about 5 to 10 hours. The tension even after 16 hours was much below the original level (See graphs 2 to 5). In the remaining two eyes (absolute glaucoma 1 and secondary glaucoma 1) the fall of intra ocular tension was only 10 to 20%.

In the 35 eyes in 30 cases of glau­coma, sustained release Acetazola­mide was given along with miotics. In 32 eyes there was fall of intra ocular pressure which ranged from 40 to 60 percent (See graphs 6, 7, 8). In the remaining 3 eyes one each of simple glaucoma, secondary glaucoma and absolute glaucoma the fall was less significant [Table 3] The ten­sion remained much below the initial level even after 16 hours.

Drance et al (1961) and Garner et al (1963) have shown in their studies results similar to ours.

It will be quite clear from this study that a single dose of sustained release Acetazolamide helps to keep the tension much below the original level and eliminate the possibility of rise of intra ocular tension in between the two closes of diamox. It also avoids the necessity of giving the drug many times.

It is remarkable that none of the cases showed any marked side effect. Every patient could tolerate the drug safely, except in 4 patients who com­plained of mild abdominal discomfort and in 3 patients who had mild diuresis. Garner et al, in their study showed that of 42 patients who could not previously tolerate diamox, 36 could tolerate one 500 mgm of sus­tained release capsule of Acetazo­lamide daily with minimal or no complication for a period ranging from 6 weeks to 30 months. This is probably due to slow release or slow excretion which is achieved by the administration of the sustained re­lease acetazolamide.[5]


  Summary Top


  1. The effect of sustained release acetazolamide capsule was studied in 26 normal and 30 eyes of various types of glaucoma.
  2. The effect of sustained release acetazolamide and miotics was stud­ied in 35 eyes of 30 glaucoma cases.
  3. The maximum effect of single dose was seen after 4 to 8 hours and the maximum effect used to last for about 6 to 8 hours. The tension even 16 hours after the administration of a single dose was much below the initial level.
  4. With the doses used in this short term study there was no marked side effect seen except mild discomfort in the abdomen in 4 cases and mild diuresis, in three cases.
  5. Sustained release acetazolamide is recommended in the management of glaucoma as it assures a uniform action.


 
  References Top

1.
Agarwal, L. P. Saxena R. P (1955) Ophthalmologica 130, 164.  Back to cited text no. 1
    
2.
Agarwal, L. P. Malik, S. R. K. (1961) Brit. J. of Ophthal., 41, 613.  Back to cited text no. 2
    
3.
Becker, B. (1954) Amer. J. of Ophthal. 37-13.  Back to cited text no. 3
    
4.
Drance, S. M. Can, F, (1961) Brit. J. of Ophthal. 45, 695.  Back to cited text no. 4
    
5.
Garner, L. L. Carl, E. F, Ferwerda, J. R. (1963) Amer. J. of Ophthal. 55, P.  Back to cited text no. 5
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8]



 

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