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Pediatric Glaucoma: Pharmacotherapeutic Options

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Abstract

Childhood glaucoma is a major therapeutic challenge for pediatric ophthalmologists and glaucoma specialists worldwide. Management depends on the etiology and age at presentation. A variety of drugs are available for the control of intraocular pressure in children; however, none of these drugs have been licensed by the regulatory agencies for use in children. Furthermore, evidence gained from randomized controlled trials in the pediatric population is sparse, and little is known regarding the use of newer anti-glaucoma preparations. This evidence-based review aims to discuss the available pharmacotherapeutic options for glaucoma in children. Topical adrenoceptor blockers, topical and systemic carbonic anhydrase inhibitors, prostaglandin (PG) analogs, adrenoceptor agonists, parasympathomimetics, and combined preparations are available for use in children, but usually as an off-label indication. Therefore, it is important to recognize that serious side effects have been reported, even with topical drops, and measures to reduce systemic absorption should be taken. Most drugs have been shown to have comparable ocular hypotensive effects, with the lowest occurrence of systemic side effects with PG analogs. Whereas a newly introduced prostaglandin analog, tafluprost, and some other preservative-free preparations have shown promising results in adult glaucoma patients, no pediatric reports are available as yet. Future studies may describe their role in treating pediatric glaucoma. This review also shares some suggested treatment pathways for primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), developmental glaucoma, aphakic/pseudophakic glaucoma, and uveitic glaucoma.

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Acknowledgments

The authors are grateful to the members of the Scientific Bureau of the World Society of Pediatric Ophthalmology and Strabismus for advice regarding the different anti-glaucoma medications available from around the world: Paolo Nucci MD, Italy; Yee Fong Choong MBChB (Leeds), FRCOphth (London), Malaysia; Nicola Freeman, South Africa; Mauro Goldchmit MD, Brazil; Simon Ko, Hong Kong; Yair Morad MD, Israel; Eduardo Duarte Silva MD, PhD, Portugal; Seo Wei Leo, Singapore; Mohammed Younis MD, FACS, Lebanon; Dominique Bremond-Gignac MD, PhD, France; Ramesh Kekunnaya MD, FRCS, India; Ivan Goldberg, Australia; David B Granet MD, USA; and Richard Hertle MD, USA.

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Authors and Affiliations

  1. Children’s Hospital of Pittsburgh of UPMC, Pediatric Ophthalmology, Strabismus, and Adult Motility, 4401 Penn Avenue, Suite 5000, Pittsburgh, PA, 15224, USA

    Monica Samant, Anagha Medsinge & Ken K. Nischal

  2. UPMC Eye Center, Pittsburgh, USA

    Monica Samant, Anagha Medsinge & Ken K. Nischal

  3. University of Pittsburgh School of Medicine, Pittsburgh, USA

    Anagha Medsinge & Ken K. Nischal

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  1. Monica Samant
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  2. Anagha Medsinge
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Correspondence to Ken K. Nischal.

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Samant, M., Medsinge, A. & Nischal, K.K. Pediatric Glaucoma: Pharmacotherapeutic Options. Pediatr Drugs 18, 209–219 (2016). https://doi.org/10.1007/s40272-016-0174-4

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