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Editors Selection IGR 11-2
Medical Treatment: Glaucoma medication in pediatric population
Comment by Anil Mandal on:
23468 The safety and efficacy of glaucoma medication in the pediatric population, Coppens G; Stalmans I; Zeyen T et al., Journal of Pediatric Ophthalmology & Strabismus, 2009; 46: 12-18
During the last few years there has been a huge increase in the number of medical therapies for glaucoma. More recent antiglaucoma medications include alpha-2 adrenergic agonists, topical carbonic anhydrase inhibitors and prostaglandin-related drugs. Coppens et al., (735) reported the results of literature review (since 1980) concerning the safety and efficacy of recent glaucoma medications in the pediatric population. Timolol is the first choice in pediatric glaucoma provided there are no cardio-respiratory problems. Topical carbonic anhydrase inhibitors are useful as secondline drugs or when β-blocker is contraindicated. The α2-agonists (brimodine) have potential serious adverse effects in children and, therefore, are contraindicated in children younger than six years of age or weighing less than 20 kg. Prostaglandin analogs are intriguing drugs to be considered in the treatment of pediatric glaucoma. They tend to be affective in lowering IOP in children with juvenile open angle glaucoma, glaucoma associated with Sturge-Weber Syndrome, and aphakic glaucoma. However, long-term studies are required to establish the safety and efficacy of the use of prostaglandin analogs in children. The potential side effects of topical antiglaucoma medication may be greater in children because of small blood volume and immature metabolic enzyme systems in neonates and young children. Therefore, punctal occlusion after topical antiglaucoma drops administration must be explained to the caregivers and should be practiced routinely in order to reduce the systemic absorption and side effects. Periodic evaluation and follow-up is essential to establish the safety and efficacy of glaucoma medications in the pediatric population.
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