Лікарські препарати, що використовуються для лікування глаукоми

Prostaglandin analogs (topical)

Bimatoprost

Primarily increases uveoscleral outflow with little effect on conventional (trabeculocanalicular) aqueous outflow

Increased pigmentation of the iris and skin

Possible worsening of uveitis

Elongated and thickened eyelashes

Muscle, joint, and back pain

Rash

Latanoprost

Tafluprost

Travoprost

Beta-blockers (topical)

Timolol

Decreases aqueous production

Systemic adverse effects (eg, bronchospasm, depression, fatigue, confusion, erectile dysfunction, hair loss, bradycardia)

Effects may develop insidiously and be attributed by patients to aging or other processes

Betaxolol

Carteolol

Levobetaxolol

Levobunolol

Metipranolol

Carbonic anhydrase inhibitors (oral or IV)

Acetazolamide

Decreases aqueous production

Used as adjunctive therapy

Cause fatigue, altered taste, anorexia, depression, paresthesias, electrolyte abnormalities, kidney calculi, and blood dyscrasias

Possibly nausea, diarrhea, weight loss

Use with caution in patients with renal failure

Methazolamide

Carbonic anhydrase inhibitors (topical)

Brinzolamide

Decreases aqueous production

Low risk of systemic effects, but may cause bad taste in mouth and/or rash

Dorzolamide

Rho kinase inhibitor (topical)

Netarsudil

Increases conventional aqueous outflow

May develop conjunctival hyperemia (redness), corneal verticillata (corneal deposits), subconjunctival petechial hemorrhages

Miotics, direct-acting (cholinergic agonists; topical)*

Carbachol

Cause miosis, increase aqueous outflow

Less effective as monotherapy than beta-blockers

Possible need for higher strengths in patients with darker-pigmented pupils

Hinder dark adaptation

Pilocarpine

Miotic, indirect-acting (cholinesterase inhibitors; topical)*

Echothiophate iodide

Causes miosis, increases aqueous outflow

Very long acting: Irreversible inhibition; can cause cataracts and retinal detachment; should be avoided in angle-closure glaucoma because of the extreme miosis; hinders dark adaptation

Systemic effects (eg, sweating, headache, tremor, excess saliva production, diarrhea, abdominal cramps, nausea) more likely than with direct-acting miotics

May still be an option in pseudophakic patients

Osmotic diuretics (oral, IV)†

Glycerin

Causes increased serum osmolarity, which draws fluid from eye

Used for acute angle closure

Has adverse systemic effects

Can rarely cause cerebral hemorrhage and acute, decompensated heart failure

Ineffective in patients with moderate to severe renal failure

Mannitol

Alpha-2-selective adrenergic agonists (topical)

Apraclonidine

Decreases aqueous production; may increase uveoscleral aqueous outflow; may cause mydriasis

With apraclonidine, high rate of allergic reactions and tachyphylaxis; less common with brimonidine, which may cause dry mouth and is contraindicated in children < 2 years

Systemic effects (eg, hypertension, tachycardia) less common than with nonselective agonists

Brimonidine