TOPICAL CARBONIC-ANHYDRASE INHIBITORS - POTENTIAL ADJUVANTS TO GLAUCOMA THERAPY IN THE FUTURE

Systemically administered carbonic anhydrase inhibitors lower intraocu lar pressure (IOP) by decreasing aqueous production. Their clinical us efulness is limited, however, because they often cause ill-tolerated s ide effects, and on occasion may be associated with serious adverse re actions. In the past, attempts at topical formulations of carbonic anh ydrase inhibitors did not achieve desired results. Recent modification s to improve pharmacokinetics have lead to the development of topical carbonic anhydrase inhibitors that decrease IOP with minimal side effe cts. Thus, this class of drugs may soon become an additional therapy f or treating open-angle glaucoma. This paper discusses the development of topical carbonic anhydrase inhibitors, including both unsuccessful and promising endeavors. It also summarizes the current understanding of the chemistry, mechanisms of action, pharmacokinetics, and side eff ects of these future glaucoma therapy adjuvants.