Prolonged dorzolamide treatment appears to increase central corneal thickness in patients with cornea guttata

This randomized, placebo-controlled study finds that patients with cornea guttata who used dorzolamide for four weeks experienced a statistically significantly increase in central cornea thickness. The authors recommend physicians closely monitor patients with corneal endothelial problems taking dorzolamide. 
 
Dorzolamide inhibites cytosolic carbonic anhydrase isoenzymes II and IV, which are found both in the nonpigmented epithelium of the ciliary processes and mediates the state of dehydration of the corneal endothelial pump. There have been reports of irreversible corneal decompensation during dorzolamide therapy.
 
This has implications for the patient with a borderline cornea, especially when facing cataract surgery. This information is enough to encourage me to try to avoid or replace carbonic anhydrase isoenzymes when in need of IOP management in these at risk patients in the peri-operative period.