Topical timolol and epinephrine: biochemical actions and interactions in the rabbit eye in vivo

The effects of topical 0.5% timolol maleate and 1% or 2% levo-epinephrine hydrochloride on aqueous humor cyclic-AMP and intraocular pressure were assessed in 97 normotensive New Zealand white rabbits in vivo. The study was conducted using three experimental protocols: (A) timolol and epinephrine individually, (B) timolol and epinephrine in coadministration, and (C) timolol and epinephrine in crossover, applied either in a single dose, twice a day for two days, and/or twice a day for six days. These studies demonstrated that timolol has complex biochemical actions, one of which is beta-adrenergic antagonism. By itself, timolol had no effect on cyclic-AMP levels. However, when used in both single-dose coadministration and in pretreatment in six-day crossover with epinephrine, it significantly diminished the cyclic-AMP elevation produced by a single dose of epinephrine. In the six-day crossover protocol, pretreatment with timolol also significantly reduced the ocular hypotensive effect of a single dose of epinephrine, thereby correlating biochemical cause with clinical effect. Yet, timolol alone had no ocular hypotensive effect. Therefore, timolol's biochemical actions in this animal model cannot explain its marked clinical efficacy in man, which appears to depend on more complex pharmacologic actions.     

Cyclic-AMP in the aqueous humor: the effects of repeated topical epinephrine administration and sympathetic denervation

Cyclic-AMP (c-AMP) may mediate the effects of topical epinephrine on intraocular pressure in the rabbit eye. Experiments which further correlate the decrease in intraocular pressure with the increase in c-AMP in the aqueous humor in response to adrenergic agonists are presented.Repeated, daily topical administration of epinephrine led to diminished responsiveness to this drug on the fifth day. The treated eye demonstrated a smaller decrease in intraocular pressure and a smaller increase in c-AMP in the aqueous humor on the fifth day when compared to the response of a previously untreated eye.Unilateral superior cervical ganglionectomy, after a 2–3-week recovery period, causes a denervation supersensitivity to alpha-adrenergic agonists. Topical norepinephrine and epinephrine caused a greater fall in intraocular pressure and greater increase in c-AMP in the aqueous humor of the denervated eye than of the control eye. The shift to the left of the dose-response curve for epinephrine indicates a greater affinity for agonists in the denervated eye. Intravitreal injections of a high concentration of epinephrine produced a greater maximal response of c-AMP in the aqueous humor of the denervated eye. This is consistent with an increased number of sites for c-AMP production following sympathetic denervation. Speculations on the location of the adenyl cyclase system are discussed.     

Studies on the mechanism of action of timolol and on the effects of suppression and redirection of aqueous flow on outflow facility

Long-term use of drugs that suppress aqueous humor formation, such as timolol and dorzolamide, or that redirect aqueous humor outflow from the trabecular meshwork, such as prostaglandin F2alpha analogues, could cause underperfusion of the trabecular meshwork and a secondary decrease in outflow facility. We investigated the mechanism of suppression of aqueous humor formation by timolol in monkey eyes by measuring aqueous humor ascorbate levels. We also determined whether suppression of aqueous humor formation with and without redirection of aqueous humor away from the trabecular meshwork could lead to a subsequent reduction in outflow facility, and whether this reduction was correlated with increased fibronectin levels in anterior chamber aqueous humor. In cynomolgus monkeys, unilateral dose/aqueous humor formation response curves were generated for timolol, dorzolamide, and a combination of timolol + dorzolamide. Aqueous humor formation and/or outflow facility were measured in both eyes after approximately four days, four weeks and seven weeks of twice daily treatment with 3.5 microg timolol + 1.0 mg dorzolamide to one eye and 30% DMSO to the other. In some monkeys, 5 microg prostaglandin F2alpha-isopropyl ester (PG) was added to timolol + dorzolamide for 4-week treatments. Intraocular pressure and corneal endothelial transfer coefficients (k(a)) were also measured at four weeks. Aqueous humor fibronectin levels were determined in four monkeys after approximately 9.5 weeks of timolol + dorzolamide treatment. Aqueous humor formation, intraocular pressure, and aqueous humor ascorbate levels were also determined in rhesus monkeys at baseline and after a single unilateral topical administration of 25 microg timolol. Compared to baseline for the same eye, aqueous humor formation was significantly decreased in treated eyes at all doses of timolol and at 1.8 and 4 mg dorzolamide. Compared to the opposite control eye, aqueous humor formation was lower in treated eyes after 3.5 and 5 microg timolol and after all doses of dorzolamide. Aqueous humor formation after treatment with 3.5 microg timolol + 1.0 mg dorzolamide was decreased in treated vs. control eyes, after four days and was suppressed in both treated and control eyes after four weeks of treatment, but not when PG was added. There was no difference in k(a) values with or without the addition of PG. Intraocular pressure was significantly lower in both treated and control eyes vs. baseline after approximately 6.5 weeks treatment with timolol + dorzolamide when taken 2 hr after the last dose and after approximately 3.5 weeks treatment with timolol + dorzolamide + PG when measured 6 hr after the last dose. Outflow facility after treatment with timolol + dorzolamide was unchanged after four days, tended to be lower in the treated vs. control eyes after four and seven weeks, and was significantly lower in treated vs. control eyes after four weeks treatment with timolol + dorzolamide + PG (0.352 +/- 0.052 vs. 0.515 +/- 0.096 microl min(-1) mmHg(-1), p < or = 0.02). Both treated vs. control eye aqueous humor fibronectin levels were below the level of detection for our assay (0.01 microg ml(-1)). The 25 microg timolol dose decreased ipsilateral, but not contralateral intraocular pressure (12.6 +/- 1.7 vs. 15.2 +/- 0.9; p < 0.05) and aqueous humor formation (1.40 +/- 0.08 vs. 2.03 +/- 0.09 microg ml(-1), p < or = 0.01). There was no difference in anterior chamber ascorbate levels in treated vs. control eyes or compared to their respective baselines. Our findings indicate that timolol affects neither ciliary epithelial transport of ascorbate nor aqueous fibronectin levels. Our data also indicate that decreasing aqueous humor formation over a period of time can lead to reduction in outflow facility, particularly when combined with therapy that redirects aqueous from the trabecular meshwork. Future intraocular pressure-lowering therapies for glaucoma may better be directed at enhancing flow through the trabecular pathway as opposed to decreasing aqueous humor formation or rerouting aqueous humor away from the trabecular meshwork.     

Aqueous humor pilocarpine and timolol levels after instillation of the single drug or in combination

Aqueous humor levels of pilocarpine and timolol in rabbits after administration of either 2% pilocarpine or 0.5% timolol in single-drug solutions were compared with the concentrations found after instillation of a fixed combination of 0.5% timolol and 2% pilocarpine drops. Time intervals considered were 15 min, 30 min, 1 hr, 4 hr, and 8 hr after application. Drug concentrations were analyzed in individual aqueous samples by high-performance liquid chromatography. No statistically significant differences in either pilocarpine or timolol concentrations in aqueous humor were found at any time tested between the single-drug preparations and the combination.     

Comparison of the effects of timolol and other adrenergic agents on intraocular pressure in the rabbit.

The effect of timolol, propranolol, epinephrine, and isoproterenol on intraocular pressure (IOP) (measured by tonometry) were compared after topical administration in conscious rabbits. Epinephrine and isoproterenol decreased IOP in normotensive rabbits, whereas propranolol had no effect. Timolol produced only a slight and inconsistent lowering of IOP in normotensive rabbits. All four agents reduced IOP elevated by an oral water load; the adrenergic agonists were substantially more active than the two beta-adrenergic blocking agents. In alpha-chymotrypsin-induced ocular hypertension, epinephrine, isoproterenol, and timolol were essentially equally effective, whereas propranolol exhibited only weak activity. In this latter model, timolol did not lose its effectiveness after multiple instillations (three/day) over an 8-day period. The concentration of timolol in the acqueous humor after topical application of effective hypotensive doses was relatively high as compared to that found in plasma. In addition, topical doses of timolol required to lower IOP were considerably greater than those needed to reduce or block the ocular hypotensive activity of isoproterenol. The mode of action and therapeutic implications of beta-adrenergic blocking agents in glaucoma are discussed.     

Study of the additive effect of timolol and epinephrine in lowering intraocular pressure.

A randomised, double-masked clinical study was conducted in patients with primary open-angle glaucoma to determine if timolol and epinephrine have an additive effect in lowering intraocular pressure. Sixteen patients were randomly assigned to one of 2 treatment sequences (timolol alone, supplemented after 2 weeks with epinephrine, and vice versa). An initial additive effect in lowering intraocular pressure was found in both sequences. However, after several weeks of combined therapy complete loss of additive effect was found. Patients who were treated first with epinephrine for 2 weeks and then supplemented with timolol had significantly lower intraocular pressures for at least 2 weeks than patients in the reverse treatment sequence. Epinephrine treatment alone caused a significant increase in facility of outflow, but this effect did not occur with simultaneous timolol treatment. The results are discussed in terms of possible fundamental beta and alpha adrenergic influences on aqueous dynamics and their potential clinical relevance.     

Contributions of adenosine receptor activation to the ocular actions of epinephrine.

PURPOSE: Epinephrine is an effective drug for glaucoma treatment. However, the mechanisms responsible for the ocular hypotensive action of this compound are not completely understood. Adenosine is an autacoid released by all cells. This study evaluated the role of adenosine receptor activation in epinephrine-induced changes in ocular function. METHODS: Rabbits were pretreated topically with the moderately selective adenosine A1 antagonist 8-(p-sulfophenyl)theophylline (8-SPT) or the adenosine A2 antagonist 3,7-dimethyl-l-propargylxanthine (DMPX). Epinephrine (500 microg) was then administered, and intraocular pressures (IOPs), pupil diameters (PDs), or total outflow facility was evaluated. In a separate group of animals, epinephrine or vehicle was administered, and aqueous humor samples obtained to evaluate changes in aqueous humor purine levels by means of high-performance liquid chromatography. RESULTS: In control animals, epinephrine produced a biphasic change in IOP: an initial rise in IOP of approximately 1 mm Hg from 1/2 to 1 hour followed by significant reduction in IOP of 8 to 9 mm Hg from 3 to 5 hours postadministration. These animals also exhibited a significant increase in PD of 2 to 3 mm from 1/2 to 2 hours postadministration. Pretreatment with 8-SPT (1000 microg) enhanced the initial rise in IOP, while significantly inhibiting the ocular hypotensive response. Pretreatment with 8-SPT also significantly enhanced the epinephrine-induced increase in PD. Inhibition of the epinephrine-induced reduction in IOP by 8-SPT was dose-related with an IC50 of 446 microg. Administration of 8-SPT alone did not significantly alter IOP or PD. The A2 antagonist DMPX did not alter the epinephrine-induced change in IOP or PD. In rabbits pretreated with 8-SPT, the epinephrine-induced increase in outflow facility was significantly reduced by 60% when compared with those in rabbits treated with epinephrine alone. In vehicle-treated rabbits, aqueous humor adenosine and inosine levels were 2.7 +/- 0.38 and 29 +/- 4.2 ng/100 microl, respectively. Three hours after epinephrine administration, adenosine and inosine levels had significantly increased to 11 +/- 1.6 and 66 +/- 4.4 ng/100 microl, respectively. CONCLUSIONS: These results support the idea that in rabbits epinephrine administration stimulates adenosine release in the anterior segment. This rise in endogenous levels of adenosine then leads to the activation of ocular adenosine receptors and is in part responsible for the ocular hypotensive action of epinephrine.     

Synthesis of prostaglandin E in rabbit eyes with topically applied epinephrine

Using radioimmunoassay techniques, we measured the amounts of prostaglandin E (PGE) in the aqueous humor and vitreous body of 22 phakic and ten aphakic rabbit eyes. Either epinephrine and placebo, epinephrine and indomethacin, indomethacin and placebo, or placebo and placebo were administered topically for 5 months. Treatment of aphakic eyes was initiated 1 month after intracapsular lens extraction. Topically applied epinephrine apparently induced the synthesis of prostaglandin, manifested by elevated PGE in the aqueous and vitreous. Phakic eyes treated with epinephrine and placebo had mean PGE levels of 407.33 pg/ml in the aqueous and 177.0 pg/ml in the vitreous, whereas control eyes given only placebo had mean levels of 165.83 in aqueous and 59.17 in vitreous. Topically applied indomethacin inhibited epinephrine-induced synthesis of PGE in the aqueous humor, but had no significant effect in the vitreous. PGE levels, higher in placebo-treated aphakic eyes than in phakic ones, were elevated further by epinephrine treatment (from 388.40 to 1851.60 pg/ml in aqueous of aphakic eyes, and from 236.40 to 850.60 pg/ml in vitreous also of aphakic eyes). Our findings relate to the pathogenesis of epinephrine-induced maculopathy and to the mechanism of the ocular hypotensive effect of epinephrine.     

Naphazoline-induced suppression of aqueous humor pressure and flow: involvement of central and peripheral alpha(2)/I(1) receptors

The objective of this study was to examine the ocular hydrodynamic effects of topically and centrally administered naphazoline, alone and following pretreatment with pertussis toxin (PTX) and alpha(2)/I(1)receptor antagonists. Topically and intracisternally administered naphazoline was examined for its ability to alter intraocular pressure (IOP) of rabbits in the absence and presence of receptor antagonists (rauwolscine, efaroxan) and a G(i/o)ribosylating agent PTX. In addition, the topical effects of naphazoline on pupil diameter and aqueous humor flow rate were evaluated. Topical unilateral application of naphazoline (7.5, 25 and 75 micro g; 25 micro l) elicited an ipsilateral dose-dependent mydriasis (2, 4 and 5.5 mm) that peaked at 2 hr with a duration of up to 5 hr. The IOP decreases induced by naphazoline were bilateral and dose-dependent (3, 6 and 10 mmHg); the response peaked at 1 hr and lasted for up to 5 hr. Pretreatment with efaroxan (250 micro g) elicited significantly greater antagonism of the ocular hypotensive response to naphazoline than did rauwolscine (250 micro g) suggesting an involvement of imidazoline (I(1)) receptors. Intracisternal application of naphazoline (3.3 micro g) also produced bilateral reductions (6 mmHg) of IOP that were immediate (10 min post drug) and lasted for approximately 2 hr. In PTX-pretreated (2.5 micro g kg(-1), i.a.) rabbits, the ocular hypotensive effects of naphazoline by both routes (topically and centrally) were attenuated by 50--65%. In addition to producing ocular hypotension, topical application of naphazoline (75 micro g; 25 micro l) caused significant reduction, from 2.8 to 1.5 micro l min(-1), in aqueous humor flow. These in vivo data indicate that, regardless of route of administration, alteration of aqueous humor flow by naphazoline was induced by the activation of alpha(2)and I(1)receptors. The ocular hypotensive effects produced by central administration did not result in sedation, therefore, there is the suggestion that central alpha(2)adrenergic receptors were stimulated minimally by naphazoline. Thus, these data suggest that ocular hypotensive effects and suppression of aqueous humor flow rate by naphazoline are mediated, in part, by alpha(2)and/or central I(1)at both central (brain) and peripheral (eye) sites. Moreover, these data indicate that the receptors are linked to PTX-sensitive G((i/o))proteins.     

The effects of withdrawal of timolol in chronically treated glaucoma patients

The dynamics of aqueous humor were studied before and after discontinuing timolol maleate in chronic users. Nineteen patients (mean length of treatment, 44 months) were studied by measuring their baseline intraocular pressure (IOP) and aqueous humor flow during treatment and 2 days to 6 weeks after discontinuing the drug. Flow did not increase significantly until 4 days after discontinuing timolol, and IOP did not increase significantly until 14 days later. Flow did not revert to its normal rate for 2 to 6 weeks. Intraocular pressure was 15% lower and the flow 24% lower during maintenance treatment than 1 month after discontinuing timolol. This comparison demonstrates the efficacy of chronic treatment. Recovery of aqueous flow is slow after stopping timolol. This finding suggests that lower or less frequent doses than are customarily used might be equally efficacious. If timolol is discontinued before filtration surgery, its effects will remain for 2 to 4 weeks.     

Effects of betaxolol/timolol on epinephrine stimulated cyclic-AMP levels in human trabecular meshwork cells

The effects of timolol and betaxolol were compared for blocking beta agonist stimulation of cyclic-AMP in cultured human trabecular meshwork cells. Epinephrine (10^–5 M) produced a large and rapid increase in HTM cyclic-AMP; timolol (10^–6 M), at concentrations readily achieved in the aqueous humor after 0.5% eyedrops, completely blocked this effect. Recovery from timolol treatment appeared to be relatively slow, with only a 30–40% recovery observed by 9 hours. In comparison, betaxolol (10^–6 M) produced a smaller blockade of the epinephrine effects; a rapid recovery from the betaxolol effects was observed, with a greater than half-maximal response to epinephrine observed 15 minutes after removal of this beta blocker. These findings may help to explain the clinical observations of an outflow facility effect of epinephrine when used in combination protocols with betaxolol, but not with timolol.     

Pharmacokinetic basis for nonadditivity of intraocular pressure lowering in timolol combinations

The authors determined whether the ocular absorption of topically applied timolol in the pigmented rabbit was affected significantly by coadministration with either pilocarpine or epinephrine in the same drop to explain the nonadditivity in intraocular pressure lowering (IOP) seen clinically. They instilled 25 microliters of 0.65% timolol maleate solution (equivalent to 0.5% timolol), both in the presence and absence of 2.6% pilocarpine nitrate or 1% epinephrine bitartrate, into pigmented rabbit eyes. The time course of timolol concentration in the conjunctiva, anterior sclera, corneal epithelium, corneal stroma, aqueous humor, iris-ciliary body, and lens was monitored for 360 min by using reversed-phase high-performance liquid chromatography. The area under the timolol concentration-time curve in all but one of the anterior segment tissues was reduced by 20-50% (mean, 40%) when timolol was coadministered with pilocarpine and by 20-70% (mean, 42%) when timolol was coadministered with epinephrine. Such an effect was not a result of alterations in corneal permeability or aqueous humor turnover rate, nor was it related to the extent of systemic absorption caused by pilocarpine and epinephrine. Rather, the reduction in ocular timolol absorption may have been caused by the accelerated washout of timolol by tears stimulated by the coadministered drugs and, to a lesser extent, by the loss of timolol through binding to the increased amount of tear proteins induced by the coadministered drugs. Thus, the nonadditivity in IOP lowering from timolol-pilocarpine and timolol-epinephrine combinations is probably caused by changes in precorneal timolol clearance.     

The effects of forskolin on cyclic AMP, intraocular pressure and aqueous humor formation in rabbits

Forskolin was used to study cyclic AMP-mediated regulation of aqueous humor dynamics in rabbits. Crystalline forskolin was solubilized in oil and its pharmacological effects were studied both in vitro and following topical ocular administration. In vitro, using cultured corneal epithelial cells, forskolin rapidly stimulated cyclic AMP production and in vivo increased cyclic AMP concentration in the aqueous humor 10-fold following topical administration. The effect of topical forskolin on intraocular pressure and aqueous humor formation was determined in vivo using pneumatonometry and fluorophotometry, respectively. Forskolin caused a prolonged reduction of intraocular pressure and decreased aqueous humor formation. The ability of forskolin to potentiate the ocular hypotensive effect of epinephrine was investigated. Forskolin in combination with epinephrine caused a decrease in intraocular pressure of longer duration than either 0.1% epinephrine or 1% forskolin administered separately. Forskolin caused a small but significant increase in the permeability of the blood-aqueous barrier at the time of maximal intraocular pressure reduction. This effect on the blood-aqueous barrier may explain the inhibitory effect of forskolin on aqueous humor formation.     

Effects of multiple dosing of epinephrine on aqueous humor dynamics in human eyes.

Numerous studies have provided conflicting evidence to explain the ocular hypotensive mechanism of action of epinephrine. Although epinephrine has been shown consistently to increase outflow facility, its effects on aqueous flow and uveoscleral outflow are not as clear. The purpose of this study was to clarify the effects of multiple doses of topical epinephrine on aqueous humor dynamics in human eyes. This was done by evaluating the four main parameters that determine steady state intraocular pressure. These parameters were assessed at baseline and after a week of twice-daily treatment of epinephrine hydrochloride 2% to one eye. Twenty-six human volunteers were enrolled in the study. Intraocular pressure was measured by pneumatonometry, aqueous flow and trabecular outflow facility by fluorophotometry, episcleral venous pressure by venomanometry and uveoscleral outflow by mathematical calculation. In epinephrine-treated eyes compared to baseline, intraocular pressure and aqueous flow were reduced from 21.2 +/- 0.3 to 17.1 +/- 0.2 mmHg (19%, p = .01) and 3.3 +/- 0.2 to 2.9 +/- 0.2 microl/min (12%, p = .03), respectively. Trabecular outflow facility obtained by fluorophotometry was increased from 0.18 +/- 0.02 to 0.26 +/- 0.03 microl/min/mmHg (44%, p = .02). Topical epinephrine did not significantly affect uveoscleral outflow or episcleral venous pressure. In conclusion, multiple topical doses of epinephrine lowered intraocular pressure in human volunteers by reducing aqueous humor formation and increasing trabecular outflow facility. The increase in uveoscleral outflow suggested by other studies was not observed.     

Cyclic-AMP and the ocular responses to norepinephrine

An analysis has been made of the effect of norepinephrine applied topically on the concentration of cyclic-AMP (c-AMP) in the aqueous humor of conscious rabbits prior to, and following administration of, α- and β-adrenergic receptor antagonists. Pupillary and pressure responses were also recorded. Norepinephrine increased the concentration of c-AMP in the aqueous humour. Intravenous α-adrenergic antagonist phenoxy-benzamine increased the concentration of c-AMP in the aqueous humor and an additional increment of c-AMP resulted from the topical application of norepinephrine. Phenoxybenzamine effectively prevented the pupillary and pressure response to norepinephrine. The β-adrenergic receptor antagonist propranolol, given intravenously, failed to block c-AMP accumulation induced by norepinephrine. It is concluded that endogenously released or exogenously applied norepinephrine shares with β-adrenergic agonists the ability to stimulate adenyl cyclase of the intraocular tissues, and increase the concentration of c-AMP in the aqueous humor. The results add further evidence to the concept that the physiological responses to adrenergic agonists are mediated by c-AMP and adenyl cyclase.     

Human aqueous humor catecholamines

Timolol of 0.5% was applied in 6 eyes prior to cataract extraction, while 7 eyes were not treated. Aqueous humor was drawn after retrobulbar analgesia with 2% lidocaine and analyzed for epinephrine and norepinephrine using a radioenzymatic assay. Epinephrine levels averaged 15.8 +/- 16.2 and 19.3 +/- 27.5 pg/ml in the timolol treated group and controls respectively. The corresponding values for norepinephrine were 1.59 +/- 0.55 and 1.87 +/- 0.90 ng/ml. These differences were not statistically significant. Norepinephrine levels in this study were somewhat higher than in previous reports of catecholamine levels in human aqueous humor and considerably higher than plasma levels of norepinephrine. There was no significant correlation between aqueous humor norepinephrine levels and age in the two groups combined. The mean norepinephrine levels for men and women in the two groups combined were 1.73 +/- 0.89 and 1.76 +/- 0.56 ng/ml. The difference was not statistically significant. Timolol resulted in a decrease in the intraocular pressure.     

Ocular hypertensive response to beta-adrenoceptor agonists

Acute administration of non-selective and relatively selective beta-adrenoceptor agonists elicit a monophasic fall in IOP. The present study indicates that unilateral application of certain beta-agonists on consecutive days can result in marked ocular hypertension. 1-Epinephrine, reproterol and 1-isoproterenol evoked an elevation of IOP on the second and third day after topical administration of a 2% solution in normal rabbits and in rabbits with surgically transected extraocular muscles. In contrast, the same concentration of d-isoproterenol produced hypotensive responses only when administered once daily for three consecutive days. Since d-isoproterenol did not cause a rise in IOP during chronic administration, the mechanism involved in the hypertensive response appears to be more sensitive to the levorotatory form. Administration of timolol inhibited the ocular hypertensive effect of epinephrine and reproterol. Since timolol lowers IOP by depressing formation of aqueous, it is suggested that the rise in IOP following chronic administration of beta-agonists possibly involves an increase in aqueous humor production.     

Time course of rabbit ocular inflammatory response and mediator release after intravitreal endotoxin

An inflammatory response was elicited in the rabbit eye by intravitreal injection of endotoxin. The appearance in aqueous humor of selected metabolites of arachidonic acid metabolism at various times was correlated with the influx of protein and myeloperoxidase activity in the iris-ciliary body. After intravitreal injection of endotoxin, aqueous humor protein levels increased substantially within 2 hr. This aqueous humor protein increase occurred before a significant appearance of prostaglandin E2 (PGE2) in the aqueous humor. Myeloperoxidase activity in the iris-ciliary body, a measure of polymorphonuclear leukocyte (PMN) infiltration, showed little elevation until 6 hr after endotoxin injection and then increased rapidly through 24 hr. The appearance of the leukotriene B4 (LTB4) followed a similar time course: levels in the aqueous humor were partially elevated until 6 hr after endotoxin injection, when levels begin to rise rapidly. These findings are interpreted to demonstrate the dependence of PMN infiltration on the release and accumulation of LTB4; the initial breakdown of the blood-aqueous barrier and influx of protein appears to be independent of significant release of PGE2.     

Management of acute closed-angle glaucoma with miotics and timolol.

The hypotensive effect of intramuscular or intravenous acetazolamide with frequent instillation of 2% or 4% pilocarpine in polyvinyl alcohol, or with single drops of pilocarpine in polyvinyl alcohol or oily vehicles, and the hypotensive effect of topical timolol alone and together with pilocarpine was investigated in the treatment of acute closed-angle glaucoma in 75 patients (81 eyes). The results showed that there was no marked difference in the hypotensive effect whether pilocarpine was used frequently or in a single dose, in different concentrations, or in different vehicles after acetazolamide. Topical timolol alone was not effective enough to control the intraocular pressure in acute closed-angle glaucoma, but a good hypotensive effect was seen when topical timolol was followed by pilocarpine. It is concluded that 1 drop of pilocarpine 3 hours after intravenous or intramuscular acetazolamide or after topical timolol may be sufficient to terminate an acute attack. Topical timolol may serve as a valuable alternative when systemic medication is contraindicated.     

Ocular responses to superoxide generated by intraocular injection of xanthine oxidase

Xanthine oxidase (XaO) was injected into the anterior chamber of rabbit eyes by a closed circuit perfusion system. Doses of 1.5 milliunits (mU) or greater produced a maximal leucocyte accumulation after 4 hr, with an initial elevation of ocular pressure in the first 15 min. Similar experiments on rats with intravitreal injections of 0.1-1.5 mU of XaO resulted in a significant accumulation of leucocytes after 5 hr which, at the highest dose of XaO, was partly due to traces of bacterial endotoxin in the XaO. However, in endotoxin-desensitized rats the response to 1.5 milliunits XaO was seven-fold greater than the response to endotoxin alone. Simultaneous administration of xanthine (Xa) substrate with XaO was not required to elicit cell infiltration into the anterior chamber. Dialyzed enzyme was also effective but boiling abolished the response. Addition of XaO to rabbit aqueous humor in vitro decreased the ascorbate content, consistent with the generation of superoxide from an endogenous substrate. The results suggest that enzymatically active XaO, which can cause intraocular generation of superoxide from an XaO substrate present in aqueous humor, initiates the chemotactic response. A chemotactic agent may be generated from superoxide reacting with endogenous precursors in aqueous humor or by selective activation of the lipoxygenase pathway of arachidonic acid metabolism in adjacent tissues.