Glaucoma, Secondary Congenital Medication
- Author: Inci Irak-Dersu, MD; Chief Editor: Hampton Roy Sr, MD more...
Medication Summary
Medications that decrease the aqueous production or increase the outflow are used as initial treatment in adult-onset secondary congenital glaucoma.
Beta-adrenergic blockers
Class Summary
These agents decrease aqueous production and IOP.
Timolol ophthalmic (Timoptic, Timoptic XE, Betimol)
May reduce elevated and normal IOP, with or without glaucoma, by reducing production of aqueous humor or by outflow.
Levobunolol (Betagan)
Nonselective beta-adrenergic blocking agent that lowers intraocular pressure by reducing aqueous humor production and possibly increases outflow of aqueous humor.
Alpha2-adrenergic agonists
Class Summary
These agents decrease IOP.
Brimonidine tartrate 0.2% (Alphagan, Alphagan-P 0.15% and 0.10 %)
Lowers IOP by decreasing aqueous production and increasing uveoscleral outflow.
Prostaglandin F2-alpha analogs
Class Summary
These agents decrease IOP by increasing uveoscleral outflow.
Latanoprost 0.005% (Xalatan)
May decrease IOP by increasing outflow of aqueous humor.
Bimatoprost ophthalmic solution (Lumigan)
A prostamide analogue with ocular hypotensive activity. Mimics the IOP-lowering activity of prostamides via the prostamide pathway. Used to reduce IOP in open-angle glaucoma or ocular hypertension.
Travoprost ophthalmic solution 0.004% (Travatan, Travatan Z)
Prostaglandin F2-alpha analog. Selective FP prostanoid receptor agonist believed to reduce IOP by increasing uveoscleral outflow. Used to treat open-angle glaucoma or ocular hypertension.
Unoprostone (Rescula)
Prostaglandin F2-alpha analog and selective FP prostanoid receptor agonist. Exact mechanism of action unknown but believed to reduce IOP by increasing uveoscleral outflow.
Miotics
Class Summary
These agents decrease IOP by increasing aqueous humor outflow.
Pilocarpine ophthalmic (Adsorbocarpine, Akarpine, Isopto Carpine, Pilocar, Pilostat)
Increase outflow by pulling the longitudinal part of the ciliary muscle. Indirect-acting miotics are used less commonly.
Carbonic anhydrase inhibitors
Class Summary
Decrease aqueous production and IOP. May use temporarily before surgery or longer, if patient tolerates it. Concomitant use of topical and systemic carbonic anhydrase inhibitors is not recommended.
Acetazolamide (Diamox, Diamox Sequels)
Inhibits enzyme carbonic anhydrase, reducing rate of aqueous humor formation, which, in turn, reduces IOP. Acetazolamide increases sickling in patients with sickle cell trait or disease; in these patients, methazolamide may be safer.
Methazolamide (Neptazane)
Reduces aqueous humor formation by inhibiting enzyme carbonic anhydrase, which results in decreased IOP.
Brinzolamide (Azopt)
Inhibits carbonic anhydrase, which, in turn, leads to a decrease in aqueous humor secretion. May use concomitantly with other topical ophthalmic drug products to lower IOP. If more than one topical ophthalmic drug is being used, administer drugs at least 10 min apart.
Dorzolamide (Trusopt) 2%)
Used concomitantly with other topical ophthalmic drug products to lower IOP. If more than one ophthalmic drug is being used, administer the drugs at least 10 min apart. Inhibits carbonic anhydrase, which, in turn, leads to a decrease in aqueous humor secretion.
Lopes JE, Wilson RR, Alvim HS, Shields CL, Shields JA, Calhoun J, et al. Central corneal thickness in pediatric glaucoma. J Pediatr Ophthalmol Strabismus. Mar-Apr 2007;44(2):112-7. [Medline].
Iwach AG, Hoskins HD Jr, Hetherington J Jr, Shaffer RN. Analysis of surgical and medical management of glaucoma in Sturge-Weber syndrome. Ophthalmology. Jul 1990;97(7):904-9. [Medline].
Agarwal HC, Sandramouli S, Sihota R, Sood NN. Sturge-Weber syndrome: management of glaucoma with combined trabeculotomy-trabeculectomy. Ophthalmic Surg. Jun 1993;24(6):399-402. [Medline].
Kargi SH, Koc F, Biglan AW, Davis JS. Visual acuity in children with glaucoma. Ophthalmology. Feb 2006;113(2):229-38. [Medline].
Yang LL, Lambert SR, Lynn MJ, Stulting RD. Surgical management of glaucoma in infants and children with Peters' anomaly: long-term structural and functional outcome. Ophthalmology. Jan 2004;111(1):112-7. [Medline].
Allingham R, Damji K, Freedman S, Moroi S, Shafranov G. Developmental glaucomas with associated anomalies. In: Shields' Textbook of Glaucoma. 5th ed. Philadelphia, PA 19106: Lippincott Williams & Wilkins; 2005:252-271.
Cantor LB. Glaucoma associated with congenital disorders. In: Ritch R, ed. The Glaucomas. Vol 2. St Louis: Mosby; 1989:931-960.
Eibschitz-Tsimhoni M, Lichter PR, Del Monte MA, Archer SM, Musch DC, Schertzer RM, et al. Assessing the need for posterior sclerotomy at the time of filtering surgery in patients with Sturge-Weber syndrome. Ophthalmology. Jul 2003;110(7):1361-3. [Medline].
Facts and Comparisons. Drug Facts and Comparisons. St Louis; 1999.
Freedman S, Walton D. Glaucoma in infants and children. In: Nelson L, Olitsky S, eds. Harley's Pediatric Ophthalmology. 5th ed. Philadelphia, PA 19106: Lippincott Williams & Wilkins; 2005:Chapter 14, 285-304.
Hittner HM. Aniridia. In: Ritch R, ed. The Glaucomas. Vol 2. St Louis: Mosby; 1989:869-884.
Kirwan JF, Shah P, Khaw PT. Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas. Ophthalmology. Feb 2002;109(2):316-23. [Medline].
Schottenstein EM. Peter's anomaly. In: Ritch R, ed. The Glaucomas. Vol 2. St Louis: Mosby; 1989:897-903.
Shields MB. Axenfeld-Rieger syndrome. In: Ritch R, ed. The Glaucomas. Vol 2. St Louis, Mo: Mosby; 1989:885-95.
Singh OS. Nanophthalmos guidelines for diagnosis and therapy. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. Vol 4. 2000:2846-2859.
Walsh J, Muldoon T. Glaucoma associated with retinal vitreoretinal disorders. In: Ritch R, Shield MB, Krupin T, eds. The Glaucomas. Vol 2. 1996:1055-1071.
Weiss JS, Ritch R. Glaucoma in the phakomatoses. In: Ritch R, ed. The Glaucomas. Vol 2. St Louis: Mosby; 1989:905-29.
Wilson ME, Buckley EG, Kivlin JD. Pediatric Ophthalmology and Strabismus. AAO, Basic and Clinical Science Course. 1998;6:330-345.
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