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Treatment of chronic simple glaucoma with an adrenaline/guanethidine combination at three different dosages (comparative double-blind study)

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Abstract

Undesirable side effects have limited the use of adrenaline/guanethidine combinations in the usual concentrations in the treatment of chronic simple glaucoma. Better tolerance to lower concentrations has already been demonstrated in other studies.

In the double-blind study described here, three different combinations (adrenaline 1%, 0.5% and 0.2% combined respectively with guanethidine 5%, 3% and 1%) were compared in respect of their depressive action on intraocular pressure and the tolerance shown to them. All three combinations were found to be effective.

The combination with the lowest concentration was significantly less hypotensive in its effect than the other two but the number of patients treated was too small to allow a clear distinction to be made between the effects of the other two combinations. Nevertheless, there was a tendency for the effectiveness to fall with decreasing concentration. As far as tolerance was concerned, there was little difference between the middle and lowest concentrations, the latter being that best tolerated. The excellent effect of the strongest concentration was impaired by the poor tolerance shown to it.

The comparison between the three combinations was followed by a study of the diurnal pressure changes in patients during the course of the treatment. The slow rise up to midday and the abrupt afternoon fall remain unexplained. The low concentration of the preparation had a better hypotensive action than pilocarpine, while the middle concentration proved even a little better than the beta-blocker Timolol.

Zusammenfassung

Die bisher meist verwendeten Konzentrationen von Adrenalin-Guanethidin-Kombinationen in der Behandlung des Glaucoma chronicum simplex waren wegen unangenehmen Nebenwirkungen in ihrer Anwendbarkeit begrenzt. Andere Studien zeigten die bessere Verträglichkeit schwächerer Konzentrationen.

In unserer Doppelblindstudie verglichen wir die drucksenkende Wirkung und Verträglichkeit drei verschiedener Dosen der Kombination (Adrenalin 1%, 0.5% und 0.2% kombiniert mit Guanethidin 5%, 3% und 1%). Alle drei Konzentrationen waren wirksam.

Die schwächste Konzentration ist signifikant weniger hypotensiv als die zwei anderen. Infolge eines zu kleinen Patientenkollektives konnte die mittlere Konzentration nicht eindeutig von der starken Konzentration abgegrenzt werden. Jedoch zeigt sich die Tendenz der abnehmenden Wirksamkeit mit fallender Konzentration. In Bezug auf Verträglichkeit steht die mittlere Konzentration nahe bei der schwachen, am besten ertragenen. Die gute Wirkung der starken Konzentration wird beeinträchtigt durch die schlechte Verträglichkeit.

Im Anschluß an den Vergleich der drei Dosen wurde der Tagesdruckverlauf unter Z 15000 untersucht. Der langsame Anstieg gegen Mittag und brüske Abfall am Nachmittag ist noch unerklärt. Die schwache Konzentration senkt den Druck besser als der Betablocker Timolol.

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Authors and Affiliations

  1. University Ophthalmological Clinic, Mittlere Str. 91, CH-4056, Basle, Switzerland

    U. Urner-Bloch & B. P. Gloor

  2. Statistical Department ZYMA SA, CH-1260, Nyon, Switzerland

    J. E. Aeschlimann

Authors
  1. U. Urner-Bloch
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  2. J. E. Aeschlimann
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  3. B. P. Gloor
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Urner-Bloch, U., Aeschlimann, J.E. & Gloor, B.P. Treatment of chronic simple glaucoma with an adrenaline/guanethidine combination at three different dosages (comparative double-blind study). Albrecht von Graefes Arch. Klin. Ophthalmol. 213, 175–185 (1980). https://doi.org/10.1007/BF00410987

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