Intraocular pressure response to the replacement of pilocarpine or carbachol with echothiophate

Intraocular pressure control with echothiophate iodide in children's eyes with glaucoma after cataract extraction

PURPOSE

To report the intraocular pressure (IOP)-lowering ability and side-effect profile of echothiophate iodide (EI) in the control of glaucoma in aphakic and pseudophakic eyes of children.

METHODS

The medical records of all aphakic and pseudophakic children treated with EI for IOP lowering after developing glaucoma were retrospectively reviewed.

RESULTS

A total of 32 eyes of 21 children were included. Mean age at cataract removal was 3.9 months (range, 5 days-2.7 years). Mean age of glaucoma diagnosis was 3.2 years (range, 40 days-12 years). Mean duration from cataract removal and diagnosis of glaucoma was 2.9 years (range, 16 days-12 years). EI reduced IOP in 31 of 32 eyes. Mean baseline IOP (29.1 ± 5.3 mm Hg) dropped to 19.6 ± 6.7 mm Hg. Six eyes had IOP spikes that could not be controlled with other medications when commercial unavailability led to discontinuation of EI. Average duration of use was 3.5 years. Mean final IOP on an average of 2.2 medications was 16.9 ± 5.1 mm Hg 7.9 years following initial glaucoma diagnosis. Four eyes required surgery for uncontrolled IOP. Side-effects included transient redness (3/32 eyes), not necessitating discontinuation of EI.

CONCLUSIONS

EI lowered IOP to within an acceptable range with no significant adverse events. In several patients it was the only pharmacologic agent that was successful.