Twenty-Years of Experience in Childhood Glaucoma Surgery.

Felix Mathias Wagner,Norbert Pfeiffer,Franz Grehn,Alexander Karl-Georg Schuster,Lukas Urbanek,Esther Maria Hoffmann,Julia Verena Stingl

doi:10.3390/jcm10245720

Abstract

To quantify the results of childhood glaucoma treatment over time in a cohort of children with different types of childhood glaucoma. A retrospective cohort study of consecutive cases involving children with primary congenital glaucoma, primary juvenile, and secondary juvenile glaucoma at the Childhood Glaucoma Center, University Medical Center Mainz, Germany from 1995 to 2015 was conducted. The main outcome measure was the long-term development of intraocular pressure. Further parameters such as surgical success, refraction, corneal diameter, axial length, and surgical procedure in children with different types of childhood glaucoma were evaluated. Surgical success was defined as IOP < 21 mmHg in eyes without a need for further intervention for pressure reduction. A total of 93 glaucomatous eyes of 61 childhood glaucoma patients with a mean age of 3.7 ± 5.1 years were included. The overall mean intraocular pressure at first visit was 32.8 ± 10.2 mmHg and decreased to 15.5 ± 7.3 mmHg at the last visit. In the median follow-up time of 78.2 months, 271 surgical interventions were performed (130 of these were cyclophotocoagulations). Many (61.9%) of the eyes that underwent surgery achieved complete surgical success without additional medication. Qualified surgical success (with or without additional medication) was reached by 84.5% of the eyes.

Highlights

Childhood glaucoma is a heterogeneous group of disorders that each require careful attention and understanding to prevent a lifetime of vision loss
The Childhood Glaucoma Research Network (CGRN) defined the following classification system for childhood glaucoma: primary glaucoma including juvenile open-angle glaucoma and primary congenital glaucoma and secondary childhood glaucoma including glaucoma following cataract surgery, glaucoma associated with nonacquired systemic disease or syndrome, glaucoma associated with nonacquired ocular anomalies, and glaucoma associated with acquired conditions [1]
The group with secondary childhood glaucoma was divided into glaucoma following cataract surgery; glaucoma associated with nonacquired systemic disease or syndrome (e.g., Sturge-Weber syndrome); glaucoma associated with nonacquired ocular anomalies (e.g., Peter’s anomaly Axenfeld-Rieger syndrome, and Aniridia); and glaucoma associated with acquired conditions [2]

Summary

Introduction

Childhood glaucoma is a heterogeneous group of disorders that each require careful attention and understanding to prevent a lifetime of vision loss It is characterized by intraocular pressure (IOP)-related damage to the eye and is caused by a diverse group of conditions [1,2]. Primary childhood glaucoma and secondary childhood glaucoma due to other ocular anomalies can lead to severe visual impairment and even blindness if not treated. While each of these disorders is very rare, primary congenital glaucoma (PCG) is among the most frequent [3,4]. The incidences increase in populations with higher proportion of consanguinity [5]

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