Primary open-angle glaucoma: management

Question 1

Primary open-angle glaucoma: management

Answer 1

NICE guidelines
-360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg NICE
–360° SLT can delay the need for eye drops and can reduce but does not remove the chance they will be needed at all
–second 360° SLT procedure may be needed at a later date
-Prostaglandin analogue (PGA) eyedrops:
-Beta-blocker eye drops
-Carbonic anhydrase inhibitor eye drops
-Sympathomimetic eye drops
-Surgery in the form of a trabeculectomy may be considered in refractory cases.

Prostaglandin analogues (e.g. latanoprost)
-Increases uveoscleral outflow
-Brown pigmentation of the iris, increased eyelash length

Beta-blockers (e.g. timolol, betaxolol)
-Reduces aqueous production
-Should be avoided in asthmatics and patients with heart block

Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)
-Reduces aqueous production and increases outflow
-Avoid if taking MAOI or tricyclic antidepressants
–Adverse effects include hyperaemia

Carbonic anhydrase inhibitors (e.g. Dorzolamide)
-Reduces aqueous production
-Systemic absorption may cause sulphonamide-like reactions

Miotics (e.g. pilocarpine, a muscarinic receptor agonist)
-Increases uveoscleral outflow
-Adverse effects included a constricted pupil, headache and blurred vision