What is the role of medications in the treatment of glaucoma in Sturge-Weber syndrome (SWS)?

Updated: Dec 26, 2018
  • Author: Masanori Takeoka, MD; Chief Editor: George I Jallo, MD  more...
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Answer

The goal of treatment is control of intraocular pressure (IOP) to prevent optic nerve injury. This can be achieved with the following agents:

  • Beta-antagonist eye drops - Decrease the production of aqueous fluid

  • Carbonic anhydrase inhibitors - Also decrease production of aqueous fluid

  • Adrenergic eye drops and miotic eye drops - Promote drainage of aqueous fluid

Although medical treatment of SWS glaucoma usually fails with time, it may be tried initially. This is because a significant reduction in IOP may be seen, at least temporarily, and may be helpful in clearing the cornea, thus facilitating surgical therapy. Moreover, it can be used to delay filtration surgery in younger patients. This is especially important, because the technical difficulties of operating on a smaller eye are excessive, and there is an increased tendency for scarring at the site of the scleral flap in the younger patient, reducing the chances for long-term surgical success.

Medical therapy can also be used as an adjunct to surgery. Topical antiglaucoma therapy for extended periods of time is sometimes helpful postoperatively to further reduce borderline IOP elevations without the need for reoperation. Initial medical therapy with a topical beta blocker, followed sequentially with the addition of a carbonic anhydrase inhibitor (systemic in infants and topical in older children) and topical prostaglandin (latanoprost [Xalatan]), is a reasonable protocol in patients with SWS.


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