flunarizine and Glaucoma--Open-Angle

To evaluate the efficacy and tolerability of flunarizine, a nonselective calcium channel blocker, on intraocular pressure (IOP) in patients with open-angle glaucoma (OAG) or ocular hypertension (OH).. Randomized, placebo-controlled, double blind, cross-over phase II trial.. Ten patients diagnosed with bilateral OAG or OH were included. Each patient served as his own control. On the first study visit, 1 drop of either 0.05% flunarizine or placebo was applied in the study eye. Patients were followed-up during 6 hours (0, 15, 30, and 60 min, 2, 3, 4, and 6 h) for vital signs, slit lamp examination, corneal fluorescein staining, and IOP. After a wash-out period of 4 weeks, 1 drop of either placebo or flunarizine was applied in the same eye and patients were followed-up for another 6 hours.. The flunarizine group showed a statistically significant decrease from baseline at T2, T3, T4, and T6 hours (P=0.01, P=0.03, P=0.01, and P=0.03, respectively). No significant difference in IOP decrease from baseline (P>0.06) was observed between the 2 groups. There was no statistically significant difference in all of the following parameters: limbal hyperemia, bulbar or palpebral conjunctival hyperemia, corneal staining with fluorescein, best-corrected visual acuity, comfort of eye drops, and vital signs.. The absence of a statistically significant difference in IOP reduction between the 2 groups may be due to the small number of patients included. However, a single dose of 0.05% flunarizine significantly reduced IOP when compared with baseline values, whereas this was not observed with placebo.

Topics: Administration, Topical; Blood Pressure; Calcium Channel Blockers; Cross-Over Studies; Double-Blind Method; Female; Flunarizine; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension; Pilot Projects; Tonometry, Ocular; Treatment Outcome

The authors assess the efficacy of flunarizine in improving blood flow and perimetric indices in low-tension glaucoma (LTG). A group of 20 patients with LTG well-compensated by medical treatment underwent Color Doppler Imaging (CDI) of the ophthalmic artery and posterior ciliary arteries with peak systolic velocity (PSV) and Purcelot's index (PI) evaluation. Computerized perimetry was also performed to assess MD, SF and CPSD. The parameters were measured before and after three months' therapy with flunarizine. Data before and after flunarizine treatment were: Ophthalmic artery- PSV 33.261 +/- 1.628 cm/sec vs 35.746 +/- 0.800 cm/sec (p < 0.001); PI 0.697 +/- 0.017 vs 0.627 +/- 0.031 (p < 0.001); Posterior ciliary arteries- PSV 9.385 +/- 0.751 cm/sec vs 10.738 +/- 1.566 cm/sec (p < 0.005); PI 0.673 +/- 0.056 vs 0.589 +/- 0.023 (p < 0.001). The perimetric indices were modified as follows: MD -11.002 +/- 6.574 vs -6.604 +/- 6.426 (p < 0.006); SF 5.05 +/- 5.717 vs 2.937 +/- 1.780 (p < 0.193); CPSD 10.198 +/- 13.392 vs 3.445 +/- 2.709 (p < 0.093). Oral administration of flunarizine, a calcium channel-blocker which acts at a vascular and neuronal level, improves the blood flow indices for the optic nerve, improving thereby the perimetric indices in LTG.

Topics: Administration, Oral; Aged; Blood Flow Velocity; Calcium Channel Blockers; Ciliary Arteries; Female; Flunarizine; Glaucoma, Open-Angle; Humans; Male; Middle Aged; Ophthalmic Artery; Optic Disk; Treatment Outcome; Ultrasonography, Doppler, Color; Visual Field Tests; Visual Fields