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ARTICLES
Year : 1977  |  Volume : 25  |  Issue : 2  |  Page : 27-30

Intravenous glycerol-sodium ascorbate combination as osmotic agent to reduce intraocular pressure


Christian Medical College, Vellore, India

Correspondence Address:
Swapna Samant Ray
Department of Ophthalmology Christian Medical College Vellore-632001
India
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Source of Support: None, Conflict of Interest: None


PMID: 615147

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How to cite this article:
Ray SS, Thomas A. Intravenous glycerol-sodium ascorbate combination as osmotic agent to reduce intraocular pressure. Indian J Ophthalmol 1977;25:27-30

How to cite this URL:
Ray SS, Thomas A. Intravenous glycerol-sodium ascorbate combination as osmotic agent to reduce intraocular pressure. Indian J Ophthalmol [serial online] 1977 [cited 2019 Dec 16];25:27-30. Available from: http://www.ijo.in/text.asp?1977/25/2/27/31255

The effect of osmolar agents on intraocular pressure has been known for long.[1] The osmotic effect in lowering intraocular pres­sure by oral glycerol was reported by Virno.[3] Because of its effectiveness, at the oral glycerol is preferred in mostcases to the other osmotic agents like urea and manitol.

In view of the marked ocular hypotensive action of oral glycerol, it seems reasonable to assume that if intravenous administration of the drug could be made possible a much greater hypotony of the eye ball could be obtained.

Clinical studies revealed that intravenous administration of glycerol as 30% solution in saline produced haematuria both in experimen­tal animals and man.[2]

In later studies by Virno[4] et al showed the haematuria and renal histological altera­tions can be eliminated by adding 20% solution of sodium ascorbate to the 30% glycerol and they claimed, this osmotic agent is highly eflective and safe to bring down the ocular hypertension.

The present investigation was aimed to study the efficacy of intravenous glycerol 30% with sodium ascorbate 20% as a tension lower­ing osmotic agent.


  Material and Methods Top


Vitamin C (pure crystal of ascorbic acid) was dis­solved in bidistilled water to make a 20% solution which was titrated to pH values of 7.2-7.4 with sodium bicar­bonate.

To 30 ml. of pure glycerol were added 70 ml. of 20% Vitamin C solution, titrated to pH 7.2--7.4 with sodium carbonate, to make a 100 ml. solution.

Dose administered was 1.0-1.5 gm/kg. of body weight.

Tonometric readings were taken with Schiotz tono­meter before treatment and at every 15 minutes intervals following administration. Each patient was questioned and observed regarding subjective feelings.

The effects of intravenous glycerol 30% with 20% sodium ascorbate were studied in 5 patients with glau­coma. The solution was administered at the rate of 60-80 drops per minute. Urine samples were collected from each patient at the end of infusion and examined for evidence of macroscopic and micro3copic haematu­ria.


  Results Top


Of the ten eyes analysed, 3 were suffering from chronic congestive glaucoma, three were with glaucoma of open angle type and one of them had secondary lens induced glaucoma, three had normal intraocular pressure,

[Figure - 1] shows the response to glycerol sodium ascorbate administration of a patient with chronic congestive glaucoma of the left eye. The patient was a 60 year old woman, had recurrent attacks of pain with redness in her left eye. Pre treatment pressure was 17.3 mm Hg. right eye and 49.8 mm Hg in the left eye. Intravenous glycerol sodium ascorbate was administered at the rate of 60 drops per minute. Pressure was brought down to 8.5 mm Hg right and 24.4 mm left eye within 3 hours from the start of infusion. No side effects were noticed. Blood pressure was normal and microscopic examination of the urine did not reveal any haematuria.

[Figure - 2] shows the response of a patient with lens induced glaucoma of the left eye, within 2 hours of intravenous administration of glycerol-sodium ascorbate there was a reduc­tion in pressure from 50.6 to 17.3 mm Hg left eye and from 12.2 to 8.5 mm Hg right eye. Blood pressure was normal but urine collected sample was red in colour and microscopic ex­aminations revealed plenty of R.B.C. The haematuria cleared within 2-3 hours time and subsequent microscopic examination of urine was normal.

[Figure - 3] shows the ocular hypotensive effect obtained by intravenous administration of gly­cerol sodium ascorbate. The patient 47 year old man was having open angle glaucoma in both eyes. No medical, topical or general mana­gement had been used previously. Pre treat­ment pressure was 35.8 mm Hg. right eye and 42.1 mm Hg. left eye. Within 2 hours of treat­ment, tension came down to 14.6 and 17.3 mm Hg. respectively. The patient had nausea, vomiting and had severe chills. Symptoms sub­sided after one hour.

[Figure - 4] shows the reduction in pressure in an eye with pseudoexfoliative open angle glau­coma in the left eye. Pressure was brought down after the infusion from 42.1 to 20.6 with­in 2 hours time. Right eye pressure was lowered from 17.3 to 12.2 mm Hg. This patient deve­loped chills and tremors of the extremities. Urine was normal.

[Figure - 5] shows effect of intravenous associ­ation of glycerol and sodium ascorbate in a 60 year old male patient having chronic conges­tive glaucoma in both eyes. The tension was effectively brought down from 30.4 mm Hg. in right eye to 14.6 mm Hg. and 30.4 mm Hg. in left eye to 12.2 mm Hg. within 2 hours time. At the end of the infusion this patient again developed nausea, vomiting and chills. He had mental confusion and headache. Patient came back to normal after one hour.

There was effective lowering of intraocular pressure in all the cases, but because of the side effects encountered in majority of the patients, subsequent trials with this drug was not pos­sible.


  Discussion Top


Glycerin is a trihydric alcohol with a mole­cular weight of 92. It is a viscid liquid chiefly familiar to the Ophthalmologists as an oral osmotic agent to reduce intraocular pressure and as a topical dehydrating agent for clearing oedematous corneas. Glycerol reduces the in­traocular pressure by three possible ways:­

(1) By increasing the serum osmolarity to a higher level which opposes the osmotic pull within the eye.

(2) The ciliary epithelium, retino-choroidal surface and iris providing a dehydrating inter­face for water transfer.

(3) By reducing the vitreous volume which correspondingly accompanies the weight loss shown in experimental animals. Intravenously administered glycerol probably acts in a simi­lar manner as oral glycerol but in a more effec­tive way as it is a direct administration to vas­cular volume whereas because of uncertain absorption, the hypotensive response to oral glycerol is quite variable. Sodium ascorbate by itself is an effective osmotic agent, hence addi­tion of this agent potentiates the effect of gly­cerol administered intravenously.

The results obtained in our study with the intravenous administration of sodium ascorbate20% solution and glycerol 30% showed that this combination is quite effective in significant lowering of intraocular pressure. Maximum hypotensive effect was attained after 2 hours from the start of the infusion, going at the rate of 60-80 drops per minute.

Virno,[5] considered the combination of these two drugs as a very effective and safe osmotic agent. Of 9- eyes analysed by them only 2 patients had headache. But in our serious most of the patients had severe headache, nausea, vomiting and chills. One of them had tremor of the extremities and mental confusion. one patient had micro and macroscopic haematuria as well which is reported not to be the usual side effect by Virno et al.

Headache in all these cases probably is due to sudden lowering of the inracranial pressures.

Haematuria occurs due to transient histopa­thological alterations in the kidney. It has been shown in experimenetal animals that following the administration of glycerol, there is vaso­constriction of the affarent glomerular arterioles evidenced by numerous areas of subcapsular ischaemia. A reflex vasodilatation follows. Intracapsular and interstitial haemorrhages are noted. The vasodilatation usually lasts for 5.8 hours. We presume the same process may be happening in human beings too. The addition of Vitamin C (sodium salt) had not proved use­ful in completely eliminating the haematuria.


  Conclusion Top


The combined effect of 30% glycerol and 20% sodium ascorbate is additive and produ­ces marked hypotensive effect but because of the side effects commonly met with as seen in our present study this combination may not be a very safe osmotic agent[6].

 
  References Top

1.
Cantonnet, A., 1904, Arch. Ophthal. 24, 1.  Back to cited text no. 1
    
2.
Dell Rocca et al, 1966, Gaz. Ind. Med, Chir., 71, 1160  Back to cited text no. 2
    
3.
Virno, M. et al, 1963, Amer. Jour. Ophthal. 55, 1133  Back to cited text no. 3
    
4.
Virno, M. et al, 1965, Policlinico (Sez Part) 72, 1746  Back to cited text no. 4
    
5.
Virno, M. et al, 1966, Amer. Jour. Ophtha!. 62, 825  Back to cited text no. 5
    
6.
William H. Havener, 1970, Ocular Pharmacology, II ed. The C.V. Mosby Co., Saint Louis  Back to cited text no. 6
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]



 

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