Letter to the Editor
Therapeutic conflict in patients with COVID-19 and glaucoma
Conflicto terapéutico en pacientes con COVID-19 y glaucoma
Elena Millá Griñó
, María Jesús Muniesa Royo, Marta Pazos López
Corresponding author
Institut Clínic d’Oftalmología, Hospital Clínic, Barcelona, Spain
Read
2827
Timeswas read the article
448
Total PDF
2379
Total HTML
Share statistics
array:24 [ "pii" => "S2387020620303235" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.05.009" "estado" => "S300" "fechaPublicacion" => "2020-08-28" "aid" => "5229" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;155:182" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S002577532030347X" "issn" => "00257753" "doi" => "10.1016/j.medcli.2020.05.020" "estado" => "S300" "fechaPublicacion" => "2020-08-28" "aid" => "5229" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;155:182" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Conflicto terapéutico en pacientes con COVID-19 y glaucoma" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "182" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Therapeutic conflict in patients with COVID-19 and glaucoma" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elena Millá Griñó, María Jesús Muniesa Royo, Marta Pazos López" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Elena" "apellidos" => "Millá Griñó" ] 1 => array:2 [ "nombre" => "María Jesús" "apellidos" => "Muniesa Royo" ] 2 => array:2 [ "nombre" => "Marta" "apellidos" => "Pazos López" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020620303235" "doi" => "10.1016/j.medcle.2020.05.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620303235?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577532030347X?idApp=UINPBA00004N" "url" => "/00257753/0000015500000004/v1_202008110620/S002577532030347X/v1_202008110620/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020620303193" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.05.005" "estado" => "S300" "fechaPublicacion" => "2020-08-28" "aid" => "5220" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;155:183" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Can we use noninvasive respiratory therapies in COVID-19 pandemic?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "183" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Podemos usar terapias respiratorias no invasivas en la pandemia COVID-19?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Salvador Díaz Lobato, José Manuel Carratalá Perales, José Miguel Alonso Íñigo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Salvador" "apellidos" => "Díaz Lobato" ] 1 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Carratalá Perales" ] 2 => array:2 [ "nombre" => "José Miguel" "apellidos" => "Alonso Íñigo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775320303389" "doi" => "10.1016/j.medcli.2020.05.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320303389?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620303193?idApp=UINPBA00004N" "url" => "/23870206/0000015500000004/v2_202008242222/S2387020620303193/v2_202008242222/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020620303168" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.05.032" "estado" => "S300" "fechaPublicacion" => "2020-08-28" "aid" => "4905" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2020;155:180-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Maxillar osteonecrosis related to denosumab. Evaluation of nine cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "180" "paginaFinal" => "181" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Osteonecrosis maxilar asociada a denosumab. Análisis de 9 casos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Darío Sánchez López, Paolo Cariati, Miguel Pérez de Perceval Tara" "autores" => array:3 [ 0 => array:2 [ "nombre" => "José Darío" "apellidos" => "Sánchez López" ] 1 => array:2 [ "nombre" => "Paolo" "apellidos" => "Cariati" ] 2 => array:2 [ "nombre" => "Miguel" "apellidos" => "Pérez de Perceval Tara" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775319304233" "doi" => "10.1016/j.medcli.2019.05.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775319304233?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620303168?idApp=UINPBA00004N" "url" => "/23870206/0000015500000004/v2_202008242222/S2387020620303168/v2_202008242222/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Therapeutic conflict in patients with COVID-19 and glaucoma" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "182" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elena Millá Griñó, María Jesús Muniesa Royo, Marta Pazos López" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Elena" "apellidos" => "Millá Griñó" "email" => array:1 [ 0 => "millagrinoelena@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María Jesús" "apellidos" => "Muniesa Royo" ] 2 => array:2 [ "nombre" => "Marta" "apellidos" => "Pazos López" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Institut Clínic d’Oftalmología, Hospital Clínic, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Conflicto terapéutico en pacientes con COVID-19 y glaucoma" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic has led to major efforts in the rapid research and development of drugs that can improve the prognosis of the disease, but for which safety and efficacy have not yet been established. In particular, certain antimicrobial drugs have started to be used which have an uncertain benefit, yet to be validated, for a statistically significant number of patients, and that may also increase the risk of QT prolongation and ventricular arrhythmia, namely, chloroquine, hydroxychloroquine, azithromycin, and lopinavir/ritonavir. During the pandemic, efforts to reduce the spread and minimize the effects on health care resources require a reduction of unnecessary medical procedures and tests. And in this line, the risk of drug-related arrhythmia should be minimized so that, if a patient is found to have a significantly prolonged QT interval, drugs that further prolong it should be avoided, or administered with extreme caution. These recommendations are made while no effective treatments for COVID-19 are known and should be reviewed when more data on efficacy and safety are available.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Topical timolol maleate is a non-selective beta-adrenergic antagonist that is commonly used for the treatment of open/angle glaucoma. Its mechanism of action is to produce a decrease in intraocular pressure by reducing the production of aqueous humour at the level of beta-adrenergic receptors in ocular ciliary processes. Several studies have reported on the known systemic effects of topical timolol maleate such as bradycardia, hypotension, atrioventricular block, worsening congestive heart failure, and induction of bronchospasm.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the study by Pratt et al., the risk of bradycardia increased significantly in the 31–180 days after the start of timolol, which increased the hospitalization rate in certain cases. Therefore, since bradycardia is a potential adverse event of timolol, professionals should consider the patient's history before choosing the therapeutic regimen for their glaucoma and closely monitor such patients after initiation of treatment with these non-selective topical beta-blocker eye drops.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Furthermore, there is evidence that would suggest that the concomitant use of hydroxychloroquine together with a beta-blocker (e.g., metoprolol) would increase the bioavailability of the latter by inhibiting its metabolization through CYP2D6, which would potentially further increase these side effects.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, given that some patients with COVID-19 may suffer from glaucoma and be on topical treatment with beta-blocker eye drops, it would be advisable to consider discontinuing topical treatment with these eye drops in COVID-19 patients who are candidates for treatment with cardiotoxic antimicrobials and replace them with other anti-glaucoma therapy options such as eye drops with prostaglandin analogues or carbonic anhydrase inhibitors, as well as considering laser trabeculoplasty, if the patient's general condition allows it.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Millá Griñó E, Muniesa Royo MJ, Pazos López M. Conflicto terapéutico en pacientes con COVID-19 y glaucoma. Med Clin (Barc). 2020;155:182.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidance on minimizing risk of drug-induced ventricular arrhythmia during treatment of COVID-19: a statement from the Canadian Heart Rhythm Society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Sapp" 1 => "W. Alqarawi" 2 => "C.J. MacIntyre" 3 => "R. Tadros" 4 => "C. Steinberg" 5 => "J.D. Roberts" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cjca.2020.04.003" "Revista" => array:3 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2020" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25442458" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complete atrioventricular block due to timolol eye drops: a case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Wang" 1 => "I. Denys" 2 => "F. Chen" 3 => "L. Cai" 4 => "X. Wang" 5 => "D.R. Kapusta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40360-019-0370-2" "Revista" => array:5 [ "tituloSerie" => "BMC Pharmacol Toxicol" "fecha" => "2019" "volumen" => "20" "paginaInicial" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31791399" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between ophthalmic timolol and hospitalisation for bradycardia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N.L. Pratt" 1 => "E.N. Ramsay" 2 => "L.M. Kalisch Ellett" 3 => "T.A. Nguyen" 4 => "E.E. Roughead" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2015/567387" "Revista" => array:5 [ "tituloSerie" => "J Ophthalmol" "fecha" => "2015" "volumen" => "2015" "paginaInicial" => "567387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25874117" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of hydroxychloroquine on the bioavailability of oral metoprolol" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Somer" 1 => "J. Kallio" 2 => "U. Pesonen" 3 => "K. Pyykkö" 4 => "R. Huupponen" 5 => "M. Scheinin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2125.2000.00197.x" "Revista" => array:6 [ "tituloSerie" => "Br J Clin Pharmacol" "fecha" => "2000" "volumen" => "49" "paginaInicial" => "549" "paginaFinal" => "554" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10848718" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015500000004/v2_202008242222/S2387020620303235/v2_202008242222/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015500000004/v2_202008242222/S2387020620303235/v2_202008242222/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620303235?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 28 | 3 | 31 |
| 2024 September | 20 | 2 | 22 |
| 2024 August | 26 | 4 | 30 |
| 2024 July | 19 | 3 | 22 |
| 2024 June | 14 | 2 | 16 |
| 2024 May | 27 | 3 | 30 |
| 2024 April | 14 | 6 | 20 |
| 2024 March | 21 | 4 | 25 |
| 2024 February | 27 | 7 | 34 |
| 2024 January | 28 | 2 | 30 |
| 2023 December | 40 | 4 | 44 |
| 2023 November | 38 | 4 | 42 |
| 2023 October | 57 | 14 | 71 |
| 2023 September | 34 | 2 | 36 |
| 2023 August | 45 | 6 | 51 |
| 2023 July | 57 | 5 | 62 |
| 2023 June | 50 | 7 | 57 |
| 2023 May | 75 | 1 | 76 |
| 2023 April | 57 | 7 | 64 |
| 2023 March | 60 | 1 | 61 |
| 2023 February | 59 | 6 | 65 |
| 2023 January | 52 | 12 | 64 |
| 2022 December | 34 | 7 | 41 |
| 2022 November | 46 | 4 | 50 |
| 2022 October | 42 | 6 | 48 |
| 2022 September | 48 | 11 | 59 |
| 2022 August | 61 | 12 | 73 |
| 2022 July | 39 | 6 | 45 |
| 2022 June | 33 | 8 | 41 |
| 2022 May | 26 | 7 | 33 |
| 2022 April | 67 | 7 | 74 |
| 2022 March | 84 | 11 | 95 |
| 2022 February | 60 | 8 | 68 |
| 2022 January | 97 | 7 | 104 |
| 2021 December | 48 | 13 | 61 |
| 2021 November | 41 | 14 | 55 |
| 2021 October | 34 | 10 | 44 |
| 2021 September | 31 | 16 | 47 |
| 2021 August | 68 | 10 | 78 |
| 2021 July | 25 | 16 | 41 |
| 2021 June | 42 | 14 | 56 |
| 2021 May | 65 | 21 | 86 |
| 2021 April | 113 | 11 | 124 |
| 2021 March | 71 | 19 | 90 |
| 2021 February | 58 | 24 | 82 |
| 2021 January | 62 | 16 | 78 |
| 2020 December | 65 | 6 | 71 |
| 2020 November | 77 | 15 | 92 |
| 2020 October | 58 | 14 | 72 |
| 2020 September | 27 | 18 | 45 |
| 2020 August | 8 | 12 | 20 |
Show all
