Medical Health Encyclopedia

Combinations. Combinations of these drugs can be very effective, because they tend to have different actions. Single medications that contain two drugs are becoming available. For example, Cosopt combines timolol and dorzolamide; Timpilo is a combination of timolol and pilocarpine. Studies of these and other combinations compared to each other to single drugs are ongoing. To date, results on any superior combinations have been mixed. It should be noted that the side effects of each drug apply to any combination.

Treating the Pregnant Patient. Considerations for a pregnant woman with glaucoma can be complicated. All of the drugs used for glaucoma are absorbed by the body, cross the placenta, and are excreted in breast milk. Many have effects that can interfere or adversely affect the pregnancy itself.

Women should discuss going off medication, particularly during the first trimester, and be monitored during that time for an increasing pressure. IOP tends to drop during pregnancy, although usually not to a significant degree. If women need medications, they should try to achieve the lowest dose possible. Some drugs may have fewer effects than others. Animal studies, for example, suggest that brimonidine may be safer than other glaucoma drugs during pregnancy.

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They must also be very scrupulous about administering eye drops to allow as little medication as possible to enter the body's system. Even this approach, however, does not guarantee safety. Women with glaucoma who are planning to become pregnant might want to consider surgery before they conceive.

Considerations for Surgery

The object of standard glaucoma surgery is to reduce pressure in the eye by increasing the outflow of the aqueous fluid. Two methods are now available:

• Filtration surgery (trabeculectomy). This employs standard surgical instruments to open a passage in the eye for draining fluid.
• Laser trabeculoplasty. This procedure uses a laser to burn 80 to 100 tiny holes in the drainage area.