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H.P. Wadia, T. Realini; Effects of Systemic COX–2 Inhibitor Therapy on Intraocular Pressure . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4474.
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Purpose: Prostaglandins are potent IOP reducers. Production of endogenous prostaglandins from arachidonic acid requires the cyclo–oxygenase–2 (COX–2) enzyme. Inhibitors of this enzyme are widely used to manage systemic inflammatory conditions. This study was carried out to determine if systemic COX–2 inhibitor therapy raises IOP (theoretically by reducing endogenous production of IOP–lowering prostaglandins). Methods: 25 patients on systemic COX–2 therapy were identified from consecutive patients presenting for routine eye examinations. These were matched for age (within 5 years), sex and race to 25 similarly–identified patients receiving no COX–2 therapy. All patients in both groups were free of glaucoma, ocular hypertension, or other conditions known to affect IOP, and none were on topical or systemic medications (beta blockers, corticosteroids, etc) known to affect IOP (other than COX–2 inhibitors). Mean IOP of the two groups were compared. Results: In both groups, 17/25 patients were female and all were Caucasian. Mean IOP in the COX–2 treated group was 16.4 +/– 2.4 mmHg, compared with a mean IOP of 14.0 +/– .6 mmHg in the group not on COX–2 therapy (two–tailed t–test p=0.00019). Conclusions: Patients receiving systemic COX–2 inhibitor therapy have higher IOP than age–, sex– and race–matched controls. A possible explanation is that COX–2 inhibition reduces the endogenous production of prostaglandins, which are known to lower IOP.
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