Q: Please, explain the use of calcium channel blockers in glaucoma treatment. Do they replace other medications such as beta-blockers or are they used in conjunction with other glaucoma medication? Is it more dangerous to the patient to use calcium channel blockers when the patient is being treated for other health problems such as heart disease?
A: Calcium channel blockers represent an entirely new approach to the treatment of glaucoma. Hopefully, the advent of these drugs marks only the beginning of a trend in finding new approaches to the treatment of glaucoma over the coming years.
Previously, the only form of treatment of glaucoma has involved lowering intraocular pressure (IOP), even when IOP is normal to begin with. Although the evidence is not all in yet, calcium channel blockers have been reported to increase blood flow to the eye and to stabilize the visual field. Thus, instead of lowering IOP (although they appear to do this also), calcium channel blockers increase the resistance of the eye to glaucomatous damage. Because they represent an entirely new approach to the treatment of glaucoma, they do not replace other medications that are used in conjunction with them.
There are different types of calcium channel blockers. Some primarily affect the strength with which the heart contracts, while others affect peripheral blood vessels, making them dilate so that more blood can pass through. The calcium channel blockers used in the treatment of glaucoma ideally would be those which increase blood flow to the brain, since the eye and the brain share a common blood supply.
It remains to be determined just which patients will be helped and which will not be helped, or even perhaps harmed, by calcium channel blockers. Calcium channel blockers can also lower blood pressure, and a low blood pressure predisposes to glaucomatous damage. Therefore, we do not use these drugs at the present time in patients who have low blood pressure, but only in those with normal or high blood pressure. The patient's internist or family physician should be consulted with regard to the treatment plan.
The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.
Uveitis : Controlled clinical studies of patients with uveitis demonstrated that LOTEMAX (loteprednol etabonate ophthalmic suspension) was less effective than prednisolone acetate 1%. Overall, 72% of patients treated with LOTEMAX (loteprednol etabonate ophthalmic suspension) experienced resolution of anterior chamber cell by day 28, compared to 87% of patients treated with 1% prednisolone acetate. The incidence of patients with clinically significant increases in IOP ( ≥ 10 mmHg) was 1% with LOTEMAX (loteprednol etabonate ophthalmic suspension) and 6% with prednisolone acetate 1%.