Samant Monica, Medsinge Anagha, Nischal Ken K
Children's Hospital of Pittsburgh of UPMC, Pediatric Ophthalmology, Strabismus, and Adult Motility, 4401 Penn Avenue, Suite 5000, Pittsburgh, PA, 15224, USA.
UPMC Eye Center, Pittsburgh, USA.
Paediatr Drugs. 2016 Jun;18(3):209-19. doi: 10.1007/s40272-016-0174-4.
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.
儿童青光眼是全球儿科眼科医生和青光眼专家面临的一项重大治疗挑战。治疗方案取决于病因和发病时的年龄。有多种药物可用于控制儿童的眼压；然而，这些药物均未获得监管机构批准用于儿童。此外，从儿科人群的随机对照试验中获得的证据很少，对于新型抗青光眼制剂的使用了解甚少。本循证综述旨在讨论儿童青光眼可用的药物治疗选择。局部用肾上腺素能受体阻滞剂、局部和全身用碳酸酐酶抑制剂、前列腺素（PG）类似物、肾上腺素能受体激动剂、拟副交感神经药和复方制剂可用于儿童，但通常属于超说明书用药。因此，必须认识到，即使是局部滴眼液也有严重副作用的报道，应采取措施减少全身吸收。大多数药物已显示出具有相当的降眼压作用，其中PG类似物的全身副作用发生率最低。虽然一种新推出的前列腺素类似物他氟前列素和其他一些无防腐剂制剂在成年青光眼患者中已显示出有前景的结果，但目前尚无儿科报告。未来的研究可能会描述它们在治疗儿童青光眼方面的作用。本综述还分享了一些针对原发性先天性青光眼（PCG）、青少年开角型青光眼（JOAG）、发育性青光眼、无晶状体/人工晶状体性青光眼和葡萄膜炎性青光眼的建议治疗途径。
