Abstract
PurposeTo assess the long-term visual outcomes of children with PCG, irrespective of the type of surgical procedure, and to create visual acuity curves to help in predicting the development of visual function in these patients. The secondary aim is to identify associated factors for visual decline or loss, highlighting differences between neonatal and infantile subgroups.MethodsThe medical records of pediatric glaucoma patients from 1996 to 2017 at the University Hospital of Verona (Verona, Italy) were retrospectively reviewed. Visual acuities, surgeries, PCG subtype and etiology of vision impairment were recorded. Statistical analyses were performed to detect factors associated with vision decline.ResultsSixty-seven eyes (40 patients) were included in the study. Developmental predictive curves of visual acuity showed that children with infantile PCG had a better visual outcome than children with neonatal PCG at each step of follow-up. A good-to-moderate VA (< 1 LogMAR) was achieved in 56 eyes (83.6%), while 11 eyes (16.4%) had poor VA (≥ 1 LogMAR). The age at onset, sex, number of surgeries, intraocular pressure (IOP) control (with or without antiglaucoma drugs), axial length (AL) and corneal opacities were statistically associated with vision impairment (p < 0.01). The main cause of visual impairment was amblyopia.ConclusionsVisual outcomes of PCG significantly correlate with the age at diagnosis. Although a good long-term IOP control can often be achieved in PCG, often the visual acuity remains below the lower limits of the normal range. Poor vision in childhood is related to global developmental problems, and referral to third-level services should not be delayed to prevent vision impairment. In this regard, visual acuity curves can be a useful tool for the consultant ophthalmologist to define the visual development of children affected by PCG.
Highlights
Childhood glaucoma is a rare disease, associated with increased intraocular pressure (IOP), whose natural evolution is blindness [1, 2]. This condition can be classified as primary congenital glaucoma (PCG) or secondary glaucoma: PCG is due to trabeculodysgenesis, while secondary glaucomas can occur as a consequence of congenital or acquired ocular or systemic disorders [2,3,4,5,6]
Patients diagnosed with PCG who were assessed and surgically treated between December 1996 and June 2017 at the Glaucoma Unit of Verona University Hospital were included in the study
PCG was diagnosed based on clinical findings, following the criteria proposed by the Childhood Glaucoma Research Network (CGRN) [14]
Summary
Childhood glaucoma is a rare disease, associated with increased intraocular pressure (IOP), whose natural evolution is blindness [1, 2]. This condition can be classified as primary congenital glaucoma (PCG) or secondary glaucoma: PCG is due to trabeculodysgenesis, while secondary glaucomas can occur as a consequence of congenital or acquired ocular or systemic disorders [2,3,4,5,6]. The purpose of this study is to assess the longterm visual outcomes of children with PCG to create visual acuity curves to help the consultant ophthalmologist in predicting the development of visual function in these patients. The secondary aim is to identify associated factors for visual decline or loss in the study cohort and whether there are differences between neonatal and infantile groups
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