Drug kept as a last reso in the management of primary open angle glaucoma is ?

Ans. is 'd' i.e., Oral acetazolamide Treatment of POAG (Primary open angle glaucoma) Following treatment options are available for POAG : Medical therapy :- Total medical therapy is the treatment of choice for POAG. Topical 13-blockers (Timolol, Betoxalol, Levobunolol, caeolol) are the drugs of choice. Topical prostaglandin analogues (Latanoprost, bimatoprost, travoprost) are the second choice drugs. Other topical drugs for POAG are:- LI Alpha agonists (non - selective : epinephrine, dipivefrine; and Selective - a2: apraclonidine, brimonidine) Carbonic anhydrase inhibitors (Dorzalamide, brinzolamide) Cholinomimetic drugs (Pilocarpine, physostigmine, echothiophate, carbachol) Pilocarpire has several drawbacks, therefore, is being considered as an adjunctive therapy only as a last reso. Approach to treatment of POAG Sta monotherapy with topical P-blocker or latanoprost. If target IOT is not attained either change over to the alternative drug or use both the above concurrently. Brimonidine/dorazolamide/dipivefrine are used only when there are contraindications to PG analogues or 13-blockers. Topical miotics and oral acetazolamide are added only as the last reso. Systemic therapy is considered only as a last reso. Drugs used for systemic therapy are :- (i) Carbonic anhydrase inhibitors (Acetazolamide, Dichlorphenamide, methazolamide), (ii) Hyperosmotic agents (mannitol, glycerol).