|Year : 1972 | Volume
| Issue : 3 | Page : 123-126
Local guanethidine drops in the treatment of chronic simple glaucoma
OP Kulshrestha, PC Sharma
Department of Ophthalmology, R. N. T. Medical College, Udaipur, India
O P Kulshrestha
Department of Ophthalmology, R. N. T. Medical College, Udaipur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kulshrestha O P, Sharma P C. Local guanethidine drops in the treatment of chronic simple glaucoma. Indian J Ophthalmol 1972;20:123-6
|How to cite this URL:|
Kulshrestha O P, Sharma P C. Local guanethidine drops in the treatment of chronic simple glaucoma. Indian J Ophthalmol [serial online] 1972 [cited 2020 Aug 10];20:123-6. Available from: http://www.ijo.in/text.asp?1972/20/3/123/34656
Guanethidine (Chemical name) (2-(octahydre - 1 - azocinyl) - ethyl)guanidine sulphate) was prepared by MULL and associates of CIBA chemistry department in the year 1959 and has been used as an anti-hypertensive drug. It is available under the trade mark Ismelin (CIBA). It is a white crystalline powder, soluble in water and can be used as eye drops in 5 % and 10% strength. Guanethidine selectively inhibits sympathetic portion of autonomic nervous system by preventing liberation and causing depletion catecholamines at the postganglionic sympathetic fibres.
KEATES, KRISHNA AND LEOFOLD first reported ocular hypotensive action of intravenously used guanethidine in patients having normal intraocular pressure and those suffering from glaucoma. Guanethidine drops in strength of 5% and 10% have been found effective in patients suffering from glaucoma, particularly from chronic simple glaucoma by STEPANIK  , KUCHLE,  and CASTREN AND POHJOLA. , OosTERHUIS  found addition of 10% drops effective in lowering intraocular tension even in intractable cases of glaucoma which could not be controlled by other conservative therapy and antiglaucoma operations. The fall of tension in his cases varied from 2.5 to 22.2 mm. Hg. in 13 out of 17 glaucomatous eyes and the tension remained controlled in 5 eyes when guanethidine drops were added to previous therapy. MALIK, SooD, JAIN AND GUPTA  noted an average fall in tension of 4.83 mm. Hg. in patients suffering from chronic simple glaucoma but the tension was recorded for 2 hours only. AwASTHI, RAIZADA AND SRIVASTAVA used guane thidine drops to evaluate its hypotensive action in patients of chronic simple glaucoma. Both of these authors tried 1 % solution which is clinically ineffective in normalising intraocular tension in cases of glaucoma. Guanethidine drops are reported to reduce the production of aqueous humor (BooMI, ,, , RAGNETTI et al  ) but the processes by which the blocking of the ocular sympathetic nerve endings produce a reduction of the ciliary secretion remain unexplained D'ERMO et al  . As far as we are aware, not many reports from India are available about successful use of this drug in glaucomas.
| Material and Methods|| |
The present study was undertaken to evaluate the ocular hypotensive action of guanethidine 10% drops. Ten eyes having normal intraocular tension and 16 eyes suffering from chronic simple glaucoma were studied.
After recording the initial intraocular pressure single instillation of the drug solution was made into the conjunctival sac and intraocular pressure was recorded with Schiot'z tonometer every fifteen minutes for one hour, every half hour for next one hour, every two hours for next six hours and then at twelve and twenty four hours.
After twenty four hours one instillation of the drug solution was used at twelve hourly intervals and study was done for at least three days in all eyes. No other systemic or local ocular hypotensive drug was given.
| Observations and Discussion|| |
Action on eyes with normal intraocular tension:
Guanethidine 10% drops lowered intraocular pressure in all the eyes having normal intraocular pressure. After single instillation, intraocular pressure started falling within 45 minutes to 4 hours. Maximum fall was recorded within 4 to 6 hours which persisted for 6 to 8 hours. The fall in intraocular pressure varied from 3 to 6.5 mm. Hg. the average fall being 4.65 mm. Hg. [Table - 1].
Action on eyes of patients of chronic simple Glaucoma:
As shown in [Table - 2] Guanethidine 10% drops lowered intraocular pressure in all the 16 eyes suffering from chronic simple glaucoma.
Fall in intraocular pressure started within one to two hours of instillation of drops and was maximum within six to eight hours in all the eyes except one eye, which showed maximum fall after 12 hours. Effective control of intraocular pressure (tension below 20.5 mm. Hg.) was obtained in 10 eyes out of 16 (62.5%). Duration of effective control was 4 hours in two eyes, 8 hours in one eye, and 16 to 22 hours or more in seven eyes, Seven eyes had intraocular pressure at or below 20.5 mm Hg. even after 24 hours of single instillation of guanethidine drops. In nine eyes, out of ten showing effective control of intraocular pressure, the initial intraocular pressure readings were below 50 mm Hg.
Although tension was reduced markedly, it did not touch base level in six eyes. The tension was brought down within 22 to 28 mm Hg. in 4 eye while in the remaining two eyes it was lowered to 32 mm Hg. Five out of these six eyes, had initial intraocular pressure above 50 mm Hg. It was found that guanethidine was very effective in eyes having initial intraocular pressure below 50 mm Hg. Average percentage fall of intraocular pressure was 51.89% (range 29.72 to 73.64% ). Hypotensive effect obtained within 24 hours was maintained with local 12 hourly instillations of the drug.
Similar findings have been reported by other workers. KUTSCHERA  noted maximum fall in intraocular pressure in cases of chronic simple glaucoma after six to eight hours. CASTEREN AND POHJOLA , using 5% drops reported a fall in intraocular pressure varying from 6 to 59% (average being 37% ). Fall in intraocular pressure started within 1 hour and was maximum in 7 hours.
Effects on width of palpebral fissure and Miosis:
We found that Guanethidine 10% caused narrowing of palpebral fissure varying from 0.5 mm to 1 mm (average 0.9 mm) in eyes having normal intraocular pressure whereas in eyes having chronic simple glaucoma it varied from 1 mm to 2 mm. (average 1.08 mm). OOSTERHUIS  AND CASTREN AND POHJOLA , , have also reported narrowing of palpebral fissure with local use of these drops.
In our series small degree of miosis without significantly affecting the light reaction was noted with guanethidine in 7 normal eyes and 12 eyes suffering from chronic simple glaucoma. Miosis varied from 0.5 mm to 1 mm in normal eyes and 0.5 to 2 mm in eyes suffering from chronic simple glaucoma.
Conjunctiva showed mild congestion after instillation of these drops. No significant effect on blood pressure was recorded.
| Summary and Conclusions|| |
Study was done to evaluate the ocular hypotensive action of guanethidine drops.
Guanethidine drops in strength of 10% lowered intraocular pressure in normal eyes and in eyes suffering from chronic simple glaucoma. Guanethidine drops were very effective in glaucomatous eyes which had initial intraocular pressure below 50 mm Hg. Out of 10 such eyes tension was normalized in 9 eyes. In eyes having initial intraocular pressure over 50 mm Hg., tension came within normal level in one eye only but the remaining four eyes showed marked fall in intraocular pressure.
Guanethidine drops showed no serious side effects. Only mild congestion of conjunctiva insignificant miosis and narrowing of palpebral fissure were observed.
| Acknowledgements|| |
We are highly thankful to CIBA of India Limited for supplying the guanthidine pure substance for this study.
| References|| |
Avasthi, P., Raizada, V. N. and Shrivastava, M. P.: Ismeline 1%
in glaucoma, Indian Practitioner. 18: 681-683 (1965).
Bonomi, L. and Dicomite, P.: Outflow facility after guanethidine sul, fate administraton, Arch. Ophth, (Chicago) 78: 377-340, (1967).
Bonomi, L.: The effectiveness of Prolonged guanethedine in the treatment of intraocular pressure, Abstract in Excerpta Medica Ophthal. 21: 116, (1967).
Bonomi, L. and Ragnetti, E.: Effect of instillation of guanethidine on experimental ocular hypertension, Abstract, in Am. J. Opth. 60: 749 (1964).
Castren, J. A. and Pohjola, S.: Guanethidine and aqueous humour dynamics, Acta Ophth. 40: 358-361 (1962).
Castren, J. A. and Pohjola, S.: Effect of Guanethidine on glaucomatous eyes. Acta 40: 308-312 (1962).
D'ermo, F., Bonomi, L. and Dicomite, P.: The effects of local ad, ministration of guanethidine and B. W. 467 C 60 on the aqueous humour composition in rabbit. Ophthalmologica 153-358 (1967).
Keates, E. U., Krishna, N. and Leo. pold T. H.: Ocular effects of guanethidine and its use in Glaucoma. Symposium on Guanethidine, CIBA (1960).
Kuchle, H. J.: Local Action of guanethidine in normal and glaucomatous eyes. Abstract in Am. J. Ophthal, 53: 397 (1961).
Kutschera, E.: Clinical experience with ismelin (CIBA) Abstract in Am. J. Ophth. 53: 397 (1961).
Malik, S. R. K. Sood, G. C . , Jain, P. K. and Gupta, D. K.: Clinical experience with guanethidine on the healthy and glaucomatous eyes. Orient. Arch. of Ophtha. 2: 162167 (1964).
Maxwell, R. A., Plummer, A. J. Schneider, F., Polvalski, H. and Daniel, A. I.: Pharmacology of 2 (Octohydro - lazocinyl) guanidine sulphate. J. of Pharmacol-Exn. Ther. 128-22-29 (1960).
Oosterhuis, J. A.: Guanethidine Ismelin in Ophthalmology. If
clinical application in glaucoma A. M. A. Ophth. 67: 802-810 (1962).
Ragnetti, E. and Crepalidi, A. Aziene: Della instillazione di Guanethidine sultempo di comparsa delle fluoresceine nella camera anteriore del coniglio Ann. Ottalme clip. ocul, 91: 973. Quoted by D'Ermo, F., et al. (1965).
Stepanik, J.: The behaviour of intraocular pressure in eyes with glaucoma simplex after application of guanethidine. Isme'.in (CIBA), Abstract in Am. J. Ophth. 53: 410 (1960).
[Table - 1], [Table - 2]