Pharmacological Denervation and Glaucoma : A Clinical Trial Report with Guanethidine and Adrenaline in One Eye Drop

Glaucoma simplex or open angle glaucoma is a slow, progressive illness with an insidious course which can lead to blindness. According to our con­ temporary state of knowledge, the illness begins with a decreased outflow of aqueous humor. This leads, sometimes after a period of decreased aqueous humor production due to a feedback mechanism, to an increase in intra­ ocular pressure (lOP). An elevated lOP can eventually lead to optic nerve damage, which manifests itself morphologically as glaucomatous papillary excavation and functionally in the development of a visual field defect. The classic triad of elevated lOP, papillary excavation and visual field defect, on which the diagnosis of glaucoma was also based in earlier times, is then pre­ sent. To this can now only be added that tonography usually shows a de­ crease in aqueous humor outflow and that gonioscopy must reveal an open angle. On the basis of statistical findings, Goldmann has calculated that there may be an interval of as long as 18 years between the initial increase in lOP and the development of visual field defects. This point of view (which has been confirmed in practice) that the onset of the illness can be demon­ strated by measurement of the lOP has introduced a new element into the discussion around glaucoma, namely, the concept of ocular hypertension. This implies simply that there is an (statistically) elevated intraocular pres­ sure, even though the optic nerve may not (yet) be damaged. Front Matter....Pages i-ix Introduction....Pages 1-3 Front Matter....Pages 5-5 The Autonomic Nervous System and the Intraocular Pressure....Pages 7-21 The Pharmacology of the Eye During Denervation....Pages 23-30 The Treatment of Glaucoma with Denervation Alone....Pages 31-38 The Treatment of Glaucoma with Pharmacological Denervation and Adrenaline....Pages 39-54 Back Matter....Pages 47-54 Front Matter....Pages 55-55 Introduction to Part II....Pages 57-60 A Double-Blind Short-Term Trial of Guanethidine 3% and Adrenaline 0.5% Combined in One Eye Drop....Pages 61-68 The combination of guanethidine 3% and adrenaline 0.5% in 1 eyedrop (GA) in glaucoma treatment....Pages 69-75 Verification of the Biphasic Response in Intraocular Pressure During Treatment of Glaucoma Patients With 3% Guanethidine and 0.5% Adrenaline....Pages 77-89 Pupil Behaviour and Response of Intraocular Pressure....Pages 91-97 The Aqueous Humor Dynamics and the Biphasic Response in Intraocular Pressure Induced by Guanethidine and Adrenaline in the Glaucomatous Eye....Pages 99-104 Production and Outflow of the Aqueous Humor During a Long-Term Treatment....Pages 105-112 Maintenance Therapy of Glaucoma Patients with Guanethidine (3%) and Adrenaline (0.5%) Once Daily....Pages 113-119 The Combination of Guanethidine 1% and Epinephrine 0.2% in One Eye Drop (Ga-Weak) In the Treatment of Glaucoma....Pages 121-130 Adrenergic Therapy in Glaucoma, Especially the Combination of Guanethidine and Adrenaline in One Eyedrop....Pages 131-139 Summary....Pages 141-143 Samenvatting....Pages 145-147 Back Matter....Pages 149-150