Comorbidity in patients with primary open-angle glaucoma and ocular hypertension: potential use of a fixed-dose combination of Dorzolamide and Timolol

The pathogenesis of glaucomatous optic neuropathy involves both mechanical and vascular components. Comorbidity associated with concomitant systemic and/or ophthalmic diseases and conditions may aggravate the course of primary open-angle glaucoma (POAG) and ocular hypertension. Many patients with arterial hypertension (AH) and systemic atherosclerosis experience microcirculatory problems in the optic nerve and retina. Another additional factor contributing to microcirculatory alterations in the posterior segment of the eye may be vitreous cavity tamponade with silicone oil. In patients with POAG or ocular hypertension accompanied by microcirculatory disturbances the use of fixed combinations containing carbonic anhydrase inhibitors appears reasonable. These agents not only reduce intraocular pressure by decreasing aqueous humor production but also improve blood flow in the optic nerve and retina, increase diastolic ocular perfusion pressure, and exhibit antioxidant properties, thereby providing both indirect and direct retinoprotective effects. The article presents a series of clinical cases demonstrating the use of a generic 2 % dorzolamide and 0.5 % timolol fixed combination (DT-FC) — Dortis — in POAG or ocular hypertension patients with concomitant pathology. The first clinical case demonstrates the effectiveness of initial therapy with DT-FC in a patient with stage II B (moderate) POAG of the right eye and hypertensive retinal angiopathy (HRA) grade 1 in both eyes, associated with stage II AH (grade 3, risk 3) and coronary artery disease (stable angina pectoris, functional class II, atherosclerotic coronary artery disease). The second clinical case illustrates the effectiveness of switching to DT-FC due to insufficient hypotensive efficacy of timolol in a patient with stage II B (moderate) POAG in both eyes, a history of retinal detachment surgery of the left eye with silicone oil tamponade, and HRA grade 1 in both eyes associated with stage II AH (grade 2, risk 2). The third clinical case demonstrates the effectiveness of Dortis eye drops in a patient with ocular hypertension that developed after microinvasive vitrectomy for retinal detachment with silicone oil tamponade in the left eye, as well as HRA grade 1 in both eyes associated with stage II AH (grade 2, risk 2).

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