Wirkmechanismen, klinisches Profil und Stellenwert von Carboanhydrasehemmern in der antiglaukomatösen Therapie

 

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Zusammenfassung

Die lokalen Carboanhydrasehemmer (CAH) Dorzolamid und Brinzolamid haben sich seit ihrer Einführung fest in der medikamentösen Therapie des Glaukoms etabliert. Ihre drucksenkende Wirkung beruht auf der spezifischen Hemmung der Carboanhydrase im Ziliarepithel und der damit einhergehenden Reduktion der Kammerwasserbildung. Ihre Wirkung ist mit der von Betablockern vergleichbar, aber geringer als die von Prostaglandinanaloga. Aufgrund ihres spezifischen Wirkmechanismus erzielen sie mit allen anderen Klassen von Glaukommedikationen einen additiven drucksenkenden Effekt und eignen sich daher besonders gut für Kombinationstherapien. Zusätzlich gibt es Hinweise, dass CAH die Durchblutung im hinteren Auge verbessern. Erste Befunde an Glaukompatienten, dass Dorzolamid die Perfusion verbessert und damit das Progressionsrisiko senkt, bedürfen einer weiteren Bestätigung.

Abstract

Since their introduction the local carbonic anhydrase inhibitors (CAH) dorzolamide and brinzolamide have become well established in the drug therapy of glaucoma. They lower intraocular pressure (IOP) by blocking specifically carbonic anhydrase in the ciliary epithelium and thereby the secretion of aqueous humor. The IOP lowering effect is comparable with that of beta-blockers, but less than that of prostaglandin agonists. Because of their specific mode of action they produce an additive pressure lowering effect with any other glaucoma drug. Therefore they are ideal for being combined with other drugs. In addition, CAH may improve perfusion of the posterior eye. Preliminary results in glaucoma patients under dorzolamide therapy suggesting a reduction in the risk of progression due to enhanced blood flow need further confirmation.

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