Carbonic anhydrase inhibitors in the management of macular edema: A review of the literature

Intravitreal Bevacizumab Alone Vs Combined With Topical Timolol-Dorzolamide or Dorzolamide for Diabetic Macular Edema: A Systematic Review and Meta-Analysis

Purpose

Diabetic macular edema (DME) is a major cause of vision loss in diabetes. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of intravitreal bevacizumab (IVB) combined with topical timolol-dorzolamide versus dorzolamide alone in DME patients.

Patients and Methods

A literature search was conducted across multiple databases until March 2024. Randomized controlled trials (RCTs) comparing IVB (1.25 mg, monthly) with topical dorzolamide-timolol (twice daily) or dorzolamide alone (twice daily) were included. Primary outcomes assessed were best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) at various intervals.

Results

Four RCTs involving 98 patients (150 eyes) were analyzed, with a mean age of 57.9 years and a female predominance (55.1%). The subgroup meta-analysis indicated a weighted mean difference (WMD) in BCVA of -0.125 [95% CI: -0.21 to -0.041]. The IVB+D group showed no significant difference in WMD compared to the IVB and IVB+TD groups. IOP measurements revealed a WMD of -1.244 mmHg [95% CI: -2.548 mmHg to 0.06 mmHg], with a significant increase in the IVB group compared to the IVB+D and IVB+TD groups. CMT analysis showed a WMD of -78.875 μm [95% CI: -118.606 μm to -39.145 μm], with no significant differences among groups.

Conclusion

Concurrent IVB with topical timolol-dorzolamide or dorzolamide alone demonstrated similar efficacy in improving BCVA and CMT in DME patients. However, the IVB+TD combination resulted in a more significant reduction in IOP compared to IVB alone.

Acupuncture Combined with Periocular Injection for Treatment of Hydroxychloroquine Retinopathy with Cystoid Macular Edema: A Case Report

CONCLUSION

For HCQ retinopathy with CME, acupuncture combined with periocular injection can be used to improve the CME and protect the central vision. Subsequent research endeavors involving a more extensive cohort and extended observation periods are warranted to evaluate the effectiveness and safety profile of the intervention.

Exploring heterocyclic scaffolds in carbonic anhydrase inhibition: a decade of structural and therapeutic insights

Heterocyclic compounds represent a prominent class of molecules with diverse pharmacological activities. Among their therapeutic applications, they have gained significant attention as carbonic anhydrase (CA) inhibitors, owing to their potential in the treatment of various diseases such as epilepsy, cancer and glaucoma. CA is a widely distributed zinc metalloenzyme that facilitates the reversible interconversion of carbon dioxide and bicarbonate. This reaction is essential for numerous physiological and pathological processes. In humans, CA exists in sixteen different isoforms, labeled hCA-I to hCA-XV, each distributed across various tissues and organs and involved in crucial physiological functions. Clinically utilized CA inhibitors, such as brinzolamide, dorzolamide and acetazolamide, exhibit poor selectivity, leading to undesirable side effects. A significant challenge in designing effective CA inhibitors is achieving balanced isoform selectivity, prompting the exploration of new chemotypes. This review compiles recent strategies employed by various researchers in developing CAIs across different structural classes, including pyrazoline, quinoline, imidazole, oxadiazole, pyrimidine, coumarin, chalcone, rhodanine, phthalazine, triazole, isatin, and indole. Additionally, the review summarizes structure-activity relationship (SAR) analyses, isoform selectivity evaluations, along with mechanistic and in silico investigations. Insights derived from SAR studies provide crucial directions for the rational design of next-generation heterocyclic CA inhibitors, with improved therapeutic efficacy and reduced side effects. To the best of our knowledge, for the first time, we have comprehensively summarized all known isoforms of CA in relation to various heterocyclic motifs. This review examines the use of different heterocycles as CA inhibitors, drawing on research published over the past 11 years. It offers a valuable resource for early-career researchers, encouraging further exploration of synthetic heterocycles in the development of CA inhibitors.

Rapid Resolution of Serous Retinal Detachment in Morning Glory Disc Anomaly With Oral Acetazolamide Treatment

Morning glory disc anomaly is a rare congenital anomaly affecting the optic disc and is frequently associated with retinal detachment. This report presents a unique case of a 10-year-old boy with morning glory disc anomaly and serous retinal detachment, treated with oral acetazolamide. Remarkably, half of the retina exhibiting bullous detachment was reattached leading to full recovery of vision within a few days after starting acetazol-amide treatment. There was no recurrence after discontinuation of medication. Oral acetazolamide can be considered an alternative treatment option for retinal detachment associated with morning glory disc anomaly of non-rhegmatogenous origin. [Ophthalmic Surg Lasers Imaging Retina 2024;55:415-417.].

Topical Dorzolamide as Adjunctive Treatment With Intravitreal Bevacizumab in Bilateral Diabetic Macular Edema

BACKGROUND

 Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is accepted as the gold standard treatment for center-involving diabetic macular edema (CI-DME). Adjunctive administration of topical dorzolamide may enhance the therapeutic effects of anti-VEGF agents. In this study, we compared the efficacy of topical dorzolamide plus intravitreal injection of bevacizumab (IVB) versus IVB alone in patients with bilateral DME.

METHODS

This prospective, randomized contralateral eye study was carried out in a tertiary referral ophthalmology center, Al-Zahra Eye Hospital, Zahedan, Iran, between April 2021 and April 2022. This study included 50 eyes of 25 patients with bilateral DME. All eyes received three consecutive monthly injections of IVB. For each patient, one eye was randomized to instill dorzolamide eye drops three times a day as an intervention, and the other received artificial tear drops as a placebo. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were evaluated before starting treatment and then monthly for the first three months.

RESULTS

Among 25 included patients, the average age was 56.64 ± 7.97 years, and 48% were female. BCVA did not improve significantly in any groups (P > 0.05). No significant difference was observed in terms of BCVA between the intervention and control groups (P > 0.05). The present study showed a decrease in CMT in both study groups (P < 0.05). At month 3, the decrease in mean CMT from baseline was significantly higher in eyes receiving topical dorzolamide compared to the control group (-88.92 ± 82.90 vs. -37.64 ± 86.16 µM, respectively; P = 0.037). IOP decreased significantly only in eyes receiving dorzolamide (P < 0.001).

CONCLUSIONS

The results of the present study indicate that adjunctive administration of topical dorzolamide has a beneficial effect on CMT reduction from baseline, but it did not have an additive effect on BCVA improvement compared to IVB monotherapy.