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Editors Selection IGR 14-1
Clinical Forms of Glaucoma: Topical medical management of pediatric glaucomas
Comment by Alana Grajewski on:
49202 A Review of the Medical Treatment of Pediatric Glaucomas at Moorfields Eye Hospital, Chang L; Ong EL; Bunce C et al., Journal of Glaucoma, 2013; 22: 601-607
The use of medications in the treatment of pediatric glaucoma is often regarded as an interim treatment before surgical intervention. Chang et al. in this large retrospective case series demonstrates that topical medical management plays an important role in the management of pediatric glaucoma, especially after surgery.
Topical medical management plays an important role in the management of pediatric glaucoma, especially after surgery
The series looks at 200 consecutive patients between the ages of 0 to 18 years of age treated at Moorfields Eye Hospital from April 2006 to March 2007. In addition to the frequency of medication use in the management of these patients, as well as information regarding the pattern of treatment: monotherapy vs. combination therapy, and the effectiveness and side effects of the medications was evaluated as well. Prostaglandin analogues were the most commonly prescribed medication as monotherapy (39%) followed by non-selective beta blockers (21%). When beta blockers were used as monotherapy they were most commonly prescribed in the lowest concentrations possible (0.1 and 0.25%). As for effectiveness, the median percentage IOP reduction as monotherapy was the same for the prostaglandins and the beta blockers (17.2%) with similar responder rates for these groups consistent with the phase 3, latanoprost vs. timolol 12-week, randomized, double-masked multicenter study by Maeda-Chubacki T et al. (Ophthalmology 2011; 118: 2014-2021). Combination dorzolamide2% and timolol 0.5% appeared to have the greatest persistence of 294 days. Almost 20% with monotherapy had systemic side effects; the prostaglandin group with the least and brimonidine tartrate 0.2% with the most. Brimonidine tartrate should not be used in children less than six years of age. Limitations of the study are that it is retrospective and there were fewer prescriptions for some of the drugs compared with the prostaglandin analogue and the beta blockers: the lack of statistical difference in IOP-lowering effect may be explained by the study being underpowered to detect a difference.
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