gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Update pharmacotherapy in glaucoma

Meeting Abstract

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  • corresponding author N. Pfeiffer - Universitäts-Augenklinik, Johannes-Gutenberg-Universität Mainz, Mainz

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogFR.05.01

The electronic version of this article is the complete one and can be found online at:

Published: September 22, 2004

© 2004 Pfeiffer.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



The majority of glaucoma patients is being treated with medical therapy. Indication is an individually to high intraocular pressure in the presence of glaucomatous optic disc or visual field changes. There is also an indication for lowering of intraocular pressure in normal tension glaucoma. In contrast, medical treatment of ocular hypertension is controversial. Medical therapy is beneficial in the presence of early glaucomatous damage, good compliance, higher age and a good response to medical treatment. Therapeutic aim is to arrest or prevent glaucomatous damage by lowering intraocular pressure.


Pilocarpin has few primary indications because of miosis and accommodations spasm but is helpful in pigment-dispersion glaucoma. Adrenaline and its derivatives frequently cause hyperaemia and allergy and a small effect on IOP. However, they are helpful in steroid induced glaucoma and in pregnancy. Betablockers are amongst the most powerful medications and show few topical side effects. Those are safe systemically if contraindications (asthma, AV-block, systemic hypotony) are observed. Their rank as gold standard is disputed because of the advent of prostaglandins. They are the most powerful IOP lowering medications. Ocular side effects include hyperaemia, iris darkening and possible cystoid macular edema and reactivation of herpes. Topical carbonic anhydrase inhibitors are postulated to show a positive effect on the progression of glaucoma by improving perfusion. Alpha-2-agonists have a relatively strong IOP lowering activity. It is postulated that a neuroprotective property of one of the drugs available may also be helpful in the treatment of glaucoma.

Combination therapy may be useful because the number of applications is reduced and compliance will be improved. Medical therapy requires thorough monitoring of glaucoma. Pre-treatment IOP-levels needs to be compared to post-treatment IOPs. Because of the compliance problem progression of glaucoma must be monitored closely.