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Thread: Medical treatment in pediatric glaucomas

  1. #1

    Default Medical treatment in pediatric glaucomas

    By Dr.Reda Gomah El Garia

    Medical treatment in pediatric glaucomas


    Although management of pediatric glaucomas is almost always surgical( due to abnormal angle development),,, medical ttt has also a big role with special precautions ( whenever surgery is contraindicated or has to be postponed for awhile)
    Medical treatment pediatric glaucomas attachment.php?attachmentid=3287&d=1507308060

    So there are some critical points have to considered

    • 1st line drug is topical beta blockers ( lowest dose, gel form once daily ) serious side effects should be monitored ( apnea, bronchospasm,heart block)
    •2nd line drug topical CAI
    •3rd line systemic CAI with high precautions ( metabolic acidosis, renal failure, aplastic anemia)

    NB:
    •PG has no role in pediatric glaucomas specially below age of 8 due to abnormal uveoscleral pathway( not well developed or abnormally developed)
    •pilocarpine has no role due to trabeculodysgenesis and drug intolerance (induced myopia)
    • alpha agonist absolutely contraindicated below 2 yrs of age better to be avoided as much as possible due to CNS complications and if necessary the patient weight should be over 20 kg

    We have to know that children below 8 years are extremely steroid responder more than adults with marked IOP rise within 15 days ( as steroids not only block trabecular meshwork with deposited GAG ( glycosaminoglycans) particles but also alter the normal trabecular development as it is immature till the age of 8 yrs )











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    🛑 Medical treatment in pediatric glaucomas🌹

    ✍️ management of pediatric glaucomas is almost always surgical( due to abnormal angle development)

    ✍️ medical ttt has also a big role with special precautions ( whenever surgery is contraindicated or has to be postponed for awhile)

    some critical points have to considered

    ✍️ 1st line drug is topical beta blockers
    • ( lowest dose, gel form once daily )
    • serious side effects should be monitored ( apnea, bronchospasm,heart block)

    ✍️ 2nd line drug topical CAI

    ✍️ 3rd line systemic CAI with high precautions ( metabolic acidosis, renal failure, aplastic anemia)

    ✍️ PG has no role in pediatric glaucomas specially below age of 8 due to abnormal uveoscleral pathway( not well developed or abnormally developed)

    ✍️ pilocarpine has no role due to trabeculodysgenesis and drug intolerance (induced myopia)

    ✍️ alpha agonist absolutely contraindicated below 2 yrs of age better to be avoided as much as possible due to CNS complications and if necessary the patient weight should be over 20 kg

    ✍️ children below 8 years are extremely steroid responder more than adults with marked IOP rise within 15 days ( as steroids not only block trabecular meshwork with deposited GAG ( glycosaminoglycans) particles but also alter the normal trabecular development as it is still immature till the age of 8 yrs )

    🛑 Enjoy all my dears ❤️
    For share as much as possible , u may save child’s vision rather than life 🌹🌹🌹🌹🌹🌹🌹🌹

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