Clofibrate in chronic simple glaucoma.

The suggestion that clofibrate (Atromid-S; ethyl 2p (chlorophenoxy) -2-methylpropionate) is effective in the treatment of acute angle-closure glaucoma was recently made by Orban, Hanisch, and Vereb (i 966). These authors had previously observed a rise in the concentration offree fatty acids and in blood viscosity just before and during an attack of congestive glaucoma. Although clofibrate effectively controlled such attacks in ten cases, no details are given of the results in one case of chronic simple glaucoma (CSG) and in three cases of secondary glaucoma. Cullen (I967) reported the effect of clofibrate in ten patients with CSG or secondary glaucoma. The intraocular pressure (IOP) fell significantly in seven eyes of five patients; these, however, had not responded to other treatments and operation was envisaged. No details of other investigations on these patients were given. In a recent report, Orban (I968) stated that, of five cases of CSG, the IOP was "normalized" in one, decreased in two, and unaltered in two; clofibrate therefore was not markedly effective in cases in which the angle was open. Orban suggested three possible modes of action in those cases where the drug was effective; antilipaemic effect (but no change in IOP observed in normotensive animals eyes); cholinesterase inhibition (but no change in pupil diameter); carbonic anhydrase inhibition (but no diuresis observed). Since the lastnamed effect is not likely to be striking this would not seem to be a valid criticism. It seemed useful, therefore, to observe the effect of clofibrate on untreated proven cases of CSG with gonioscopic and tonographic control; this investigation was begun in September, i967.