Twenty-four hour control of intraocular pressure with dorzolamide and timolol maleate in exfoliation and primary open-angle glaucoma

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Abstract
Purpose To determine the efficacy and safety of adding dorzolamide 2% twice daily to timolol maleate solution 0.5% twice daily when treating exfoliation glaucoma or primary open-angle glaucoma. Methods This was a single-centre, crossover intra-individually controlled comparison. Sixty-two consecutive patients (31 with exfoliation glaucoma and 31 with primary open angle glaucoma) chronically treated with timolol maleate twice daily were included in this trial. Patients then had added dorzolamide 2% twice daily (08:00 and 20:00), instilled approximately 10 min after timolol maleate. Patients underwent diurnal intraocular pressure (lOP) testing (six measurements over 24 h), first on timolol maleate monotherapy and 2 months later following the addition of dorzolamide 2% as adjunctive therapy. Results On timolol monotherapy patients with exfoliation glaucoma had a higher mean lOP at 02:00, 06:00, 10:00, 14:00 and 22:00 hour time points as well as a higher maximum, minimum and range of lOP throughout the day compared with the primary open-angle glaucoma group (p 0.05). Following the addition of dorzolamide as adjunctive therapy to timolol maleate there was a significant reduction in lOP (p 0.05) at all time points in both glaucomas, but mean lOP at 10:00, 14:00, 18:00 and 22:00 hour time points, as well as the peak and range of lOP, remained higher in the exfoliation glaucoma group. No serious adverse events were noted with dorzolamide. Bitter taste, the most common symptom, was noted in 30% of patients. Conclusions These data suggest that dorzolamide 2% used adjunctively with timolol maleate 0.5% solution is effective in reducing diurnal lOP in patients with primary open-angle and exfoliation glaucoma but does not alter the characteristics of higher lOP levels in the latter disease.