Congenital Glaucoma Research Articles

Aqueous Humor Cytokine Profile in Primary Congenital Glaucoma.

Cytokine profile in patients with primary open-angle glaucoma (POAG) differs from that in healthy controls. Due to the different pathophysiological mechanisms involved in the genesis of primary congenital glaucoma (PCG) and POAG, it is possible that the cytokine profile could also differ. The main objective of this study was to compare the concentrations of cytokines in the aqueous humor of patients with PCG with those of POAG patients and a control group. A cross-sectional study was conducted. Aqueous humor samples were taken from PCG and POAG patients eligible for glaucoma or cataract surgery and from patients undergoing cataract surgery. Twenty-seven cytokines were analyzed using the Human Cytokine 27-Plex Immunoassay Kit (Bio-Rad Laboratories, Hercules, CA, USA). A total of 107 subjects were included: patients with PCG (n = 19), patients with POAG (n = 54), and a control group (CG) of patients undergoing cataract surgery (n = 34). Most cytokines measured in aqueous humor in PCG presented decreased values compared with POAG and controls. A statistically significant difference was observed in IL-1ra, IL-2, IL-5, IL-7, IL-8, IL-10, IL-12, IL-15, IL-17A, Eotaxin, FGF basic, G-CSF, GM-CSF, IFN-γ, MIP-1α, PDGF-bb, MIP-1β, RANTES, TNF-α, and VEGF. PCG patients have a cytokine profile in aqueous humor different from POAG patients and patients without glaucoma, characterized by lower concentrations of multiple cytokines.

The profile of childhood glaucoma — results of a 20-year retrospective study

In 2013, at the 9th Congress of the World Glaucoma Association, a new classification of childhood glaucoma was adopted.PURPOSE. This study analyzes the profile of childhood glaucoma in accordance with the new classification and evaluates the convenience of its use in clinical and research work.METHODS. We reviewed the retrospective data of 652 patients (1000 eyes) aged 0 to 18 years with childhood glaucoma who were under observation between 2002 and 2022. The mean follow-up period was 10.4±0.2 years.RESULTS. The majority of patients had bilateral glaucoma (53.4%). The most common are bilateral manifestations in primary congenital glaucoma (79.7%), juvenile glaucoma (95.8%), secondary glaucoma associated with nonacquired ocular anomalies (54%). The majority of patients in the study were male (363 patients; 56.7%). The most common diagnoses were secondary glaucoma associated with acquired conditions (42.6%), primary congenital glaucoma was diagnosed in 21% of cases. In the vast majority of cases (from 52% to 85%), the treatment of glaucoma was surgical. The maximum number of repeated hypotensive interventions (2.1 operations per eye) was required for patients with primary congenital glaucoma. The results of surgical treatment of secondary childhood glaucoma turned out to be more optimistic — one operation was enough to control glaucoma in 64.6% (62 eyes out of 96) of operated eyes with glaucoma associated with non-acquired ocular anomalies, in 70.7% of cases (29 eyes out of 41) in glaucoma associated with non-acquired systemic conditions, 66.8% in secondary glaucoma associated with acquired conditions (227 eyes out of 340), and in 68.4% of cases in glaucoma following cataract surgery (39 eyes out of 57). In the course of the observation period, 1239 glaucoma interventions were performed. The intervention of choice in all subgroups was filtering surgery. Cyclodestructive procedures were performed significantly more often (p<0.05) in the group with secondary glaucoma associated with acquired conditions. CONCLUSION. The use of a unified classification system is expected to greatly enhance the understanding of this disease, and consequently improve childhood glaucoma management approaches and standards of clinical care in rare types of this disease.>p<0.05) in the group with secondary glaucoma associated with acquired conditions.CONCLUSION. The use of a unified classification system is expected to greatly enhance the understanding of this disease, and consequently improve childhood glaucoma management approaches and standards of clinical care in rare types of this disease.

Prevalence of Risk Factors Among Patients With Glaucoma in Jeddah, Saudi Arabia

Objective The objective of this study is to estimate the prevalence of risk factors among patients with glaucoma in Jeddah, Saudi Arabia. Methods This cross-sectional study was conducted on 215 patients diagnosed with glaucoma in the period between March 2022 and August 2022 at King Abdulaziz University Hospital, in Jeddah, Saudi Arabia. We used the participants’ medical records and contacted the patients to collect information on sociodemographic characteristics and known risk factors of glaucoma. Results Among the 215 patients with glaucoma, 142 (66.0%) patients had open-angle glaucoma, 15 (7.0%) patients had closed-angle glaucoma, and 58 (27.0%) patients had congenital glaucoma. Among the patients with open-angle glaucoma, 122 (85.9%) patients were aged > 40 years, and 99 (69.7%) patients had myopia. Among the patients with closed-angle glaucoma, 13 (86.7%) patients had hyperopia and 10 (66.7%) patients were aged > 60 years. Among the patients with congenital glaucoma, 21 (36.2%) patients had a family history of congenital glaucoma and 28 (48.3%) patients had consanguine parents. Conclusion The prevalence of advanced age, hyperopia, and consanguine parents was the highest among patients with open-angle glaucoma, closed-angle glaucoma, and congenital glaucoma, respectively. These findings could inform public health policies among practitioners involved in ophthalmological care.

Risk of Developing Congenital Glaucoma in Premature Infants with Large Cup/Disc Ratio

Purpose: To investigate the risk of congenital glaucoma development in premature infants with large cup/disc ratios: a long-term follow-up study.Methods: The medical records of premature infants with cup/disc ratios of at least 0.3 were retrospectively reviewed. Ophthalmic examinations, including measurements of intraocular pressure (IOP) corneal diameter, and dilated fundoscopy, were periodically performed. Changes in the cup/disc ratio from the first examination to the last follow-up were sought, and clinical factors associated with such changes were analyzed. In addition, glaucoma development was investigated.Results: Seventy-four patients were included; they were monitored for up to 33.96 ± 19.86 months (based on corrected age). At first examination, the mean IOP was 17.12 ± 4.01 mmHg and the horizontal corneal diameter 10.34 ± 0.83 mm. The mean cup/disc ratio was 0.54 ± 0.14 at the first visit and increased significantly to 0.57 ± 0.14 at the last follow-up (<i>p</i> < 0.001). A small baseline cup/disc ratio was associated with a greater change in the cup/disc ratio (regression coefficient β = -0.111, <i>p</i> = 0.028). We found no significant association of such change with gestational age, birth weight, IOP, or corneal diameter. We encountered no case of congenital glaucoma.Conclusions: Even if the cup/disc ratio is at least 0.3 in premature infants, the risk of glaucoma does not seem to be high if the IOP is not high. Prospective studies on more patients are needed.

Long-term Results of Combined Trabeculotomy-Trabeculectomy in Primary Congenital Glaucoma.

Primary congenital glaucoma in Tunisian children seems to be characterized by a high prevalence of inherited and advanced form of the disease. Primary combined trabeculotomy-trabeculectomy allowed satisfactory long-term IOP control and reasonable visual outcome. To report the long-term outcome of combined trabeculotomy-trabeculectomy (CTT) as the initial glaucoma surgery in children with primary congenital glaucoma (PCG). Retrospective analysis of children who underwent primary CTT for PCG between January 2010 and December 2019. The main outcome measures were intraocular pressure (IOP) reduction, corneal clarity, complications, refractive errors and visual acuity (VA). Success was defined as IOP <16mmHg without (complete) or with (qualified) antiglaucoma medication. The WHO criteria of vision loss were used to categorize vision impairment (VI). 98 eyes of 62 patients were enrolled. At last follow-up, mean IOP was reduced from 22.7±4.0mmHg to 9.7±3.9mmHg (P<0.0001). Complete success rate was 91.6%, 88.4%, 84.7%, 71.6%, 59.7%, and 54.3%, at the first, second, fourth, sixth, eighth, and tenth year, respectively. Follow-up averaged 42.1±28.4 months. Preoperatively, 72 eyes (73.5%) had significant corneal edema versus 11 eyes (11.2%) at the end of the follow-up (P<0.0001). Endophthalmitis was encountered in one eye. Myopia was the most common refractive error (80.6%). Data on Snellen VA were available for 53.2% of the patients; 33.3% achieved a VA ≥ 6/12, 21.2% had mild VI, 9.1% had moderate VI, 21.2% had severe VI, and 15.2% were blind. The failure rate was statistically correlated to the early disease onset (<3mo) and to preoperative corneal edema (P=0.022 and P=0.037, respectively). Primary CTT seems to be a good procedure in a population with advanced PCG at presentation, problematic follow-up visits, and limited resources.

Analysis of glaucoma genes in Finnish patients with juvenile open-angle glaucoma.

To identify germline variants in myocilin (MYOC) and other known monogenic glaucoma genes in Finnish patients with juvenile open-angle glaucoma (JOAG). Finnish patients with JOAG treated between 2010 and 2018 at the Department of Ophthalmology, Helsinki University Hospital, Finland, were enrolled. We sequenced all exonic regions and flanking splice sites of MYOC for five patients and one healthy relative using Sanger sequencing. In 48 patients, we performed exome sequencing to identify variants also in 28 other glaucoma-related genes. Fifty-three individuals with JOAG from 50 pedigrees, and one healthy relative, participated. The mean age at diagnosis was 30.8 years [SD 7.6; range 11 to 39]. Five probands had probably pathogenic variants in MYOC: c.1102C>T p.(Gln368Ter), c.1109C>T p.(Pro370Leu), c.1130C>T p.(Thr377Met), c.1132G>A p.(Asp378Asn) and c.1456C>T p.(Leu486Phe). Four of these patients had a family history of dominantly inherited JOAG. The frequency of MYOC variants was 10% (5 of 50 families). One patient and his mother with JOAG had a novel loss-of-function variant in the FOXC1 gene, c.366G>A p.(Trp122Ter). A patient with sporadic JOAG had a homozygous likely pathogenic variant in the LTBP2 gene, c.3938G>A p.(Cys1313Tyr). The genetic variants explained 14% (7 out of 50 families; 95% CI, 6%-23%) of JOAG in our cohort. The frequency of pathogenic variants in previously known glaucoma-associated genes is low in Finnish patients with JOAG. Because of the distinct genetic background of Finns, it might be possible to identify novel glaucoma genes through our JOAG series in the future.

How many children with large clear cornea do not have glaucoma?

A horizontal corneal diameter greater than 2 standard deviations from the mean (9.8 mm) or greater than 11 mm in term infants defines megalocornea (herein referred to as a large clear cornea). The aim of the current study was to report on the incidence and clinical characteristics of children presenting with large clear cornea that do not suffer glaucoma. A retrospective chart review of children presenting with large clear cornea to the pediatric ophthalmology unit of the ophthalmology department of Alexandria Main University Hospital in the period from March 2011 to December 2020 was conducted. A large clear cornea was defined as a horizontal white-to-white corneal diameter (as measured by calipers) greater than 12 mm. Glaucoma was diagnosed according to the childhood glaucoma research network (CGRN) criteria and the axial length was used to filter out eyes with large clear corneas due to congenital high myopia. Out of 120 eyes of 91 (58 males) children a total of 76 eyes of 67 (41 males) children were diagnosed with glaucoma and 44 eyes of 24 (17 males) children (36.7%) did not suffer glaucoma. Out of these, 30 eyes were classified as myopia and 14 eyes as congenital megalocornea. More than one third of eyes presenting with large clear corneas may not have glaucoma, and almost two thirds of these eyes (that are not suffering from glaucoma) demonstrate axial myopia.

Posterior segment indications of handheld spectral domain optical coherence tomography in pediatric age group in a tertiary eye center in Egypt

Objective The aim of this study was to detect the posterior segment indications for the use of handheld optical coherence tomography in the pediatric age group. Patients and methods This was a retrospective observational study that included patients who were candidates for handheld spectral domain optical coherence tomography (HH-OCT) imaging for retinal or optic nerve (ON) diseases in Abo Elreesh hospital during the period from June 2018 to June 2022. The image, demographic, and clinical database of the included patients were reviewed. Data were tabulated using Microsoft Excel. Appropriate statistical methods were used to analyze and correlate the obtained data. Results A total of 189 patients were included in this study, comprising 109 (57.7%) male patients. The mean age was 7.2±3.9 (range: 0.2–16 years) years. Overall, 46 (24.3%) patients were less than 5 years of age (i.e. infants and preschool age). Patients who underwent HH-OCT scanning due to retinal causes (i.e. nystagmus, unexplained poor vision, uveitis, Coat's disease, trauma, and high myopia) were 130 (68.8%) patients, whereas 59 (31.2%) patients were indicated due to ON disease (i.e. primary congenital glaucoma and juvenile open angle glaucoma, optic disc hyperemia, swelling or pallor, and cases of large physiological cupping). Conclusion HH-OCT is a noninvasive feasible image modality for evaluation of retina and ON in infants and young children. The lack of a normative database for retinal nerve fiber layer thickness and ON head parameters in the pediatric age group in the device available in our service is considered a limitation in its use for proper evaluation of different pathologies involving the ON.

Comparative efficacies of 13 surgical interventions for primary congenital glaucoma in children: a network meta-analysis of randomized clinical trials.

Timely and proper intraocular pressure (IOP) management is vital to the prevention of visual impairment in children with primary congenital glaucoma (PCG). Although various surgical interventions have been proposed, no well-founded evidence exists on their comparative efficacies. We aimed to compare the efficacies of surgical interventions for PCG. We searched relevant sources up to 4 April 2022. Randomized controlled trials (RCTs) entailing surgical interventions for PCG in children were identified. A network meta-analysis (NMA) was performed, comparing 13 surgical interventions: Conventional partial trabeculotomy ([CPT] control), 240-degree trabeculotomy, Illuminated microcatheter-assisted circumferential trabeculotomy (IMCT), Viscocanalostomy, Visco-circumferential-suture-trabeculotomy, Goniotomy, Laser goniotomy, Kahook dual blade ab-interno trabeculectomy, Trabeculectomy with mitomycin C, Trabeculectomy with modified scleral bed, Deep sclerectomy, Combined trabeculectomy-trabeculotomy with mitomycin C, and Baerveldt implant. The main outcomes were mean IOP reduction and surgical success rate at postoperative 6 months. The mean differences (MDs) or odds ratios (ORs) were analyzed by a random-effects model, and the efficacies were ranked by P -score. We appraised the RCTs using the Cochrane risk-of-bias (ROB) tool (PROSPERO: CRD42022313954). Sixteen RCTs were eligible for NMA, including 710 eyes of 485 participants and 13 surgical interventions, which formed a network of 14 nodes comprising both single interventions and intervention combinations. IMCT was superior to CPT in both IOP reduction [MD (95% CI): -3.10 (-5.50 to -0.69)] and surgical success rate [OR (95% CI): 4.38 (1.61-11.96)]. The MD and OR comparing the other surgical interventions and intervention combinations with CPT were not statistically significant. The P -scores ranked IMCT as the most efficacious surgical intervention in terms of success rate ( P -score =0.777). Overall, the trials had a low-to-moderate ROB. This NMA indicated that IMCT is more effective than CPT and might be the most efficacious of the 13 surgical interventions for management of PCG.

Visco-Circumferential-Suture-Trabeculotomy Versus Rigid-Probe Viscotrabeculotomy in Neonatal-Onset Primary Congenital Glaucoma.

Angle procedures are safe and relatively effective for neonatal onset PCG. Watchful delay in intervention to close to the second month of life is helpful in ensuring diagnosis and making surgery more successful and easier. The purpose of this study was to compare the surgical outcomes of visco-circumferential-suture-trabeculotomy (VCST) to rigid-probe double-entry viscotrabeculotomy (DEVT) and rigid-probe single-entry viscotrabeculotomy (SEVT) in infants with neonatal-onset primary congenital glaucoma (PCG). This was a retrospective chart review. Retrospective chart review of 64 eyes of 64 infants with neonatal-onset PCG referred to Mansoura Ophthalmic Center in Mansoura, Egypt between February 2008 and November 2018. Study groups included VCST, DEVT, and SEVT, and follow-up covered 4 postoperative years. Complete (qualified) success was defined as intraocular pressure (IOP) ≤18mmHg and with 35% IOP reduction from baseline without (with) IOP-lowering medications or further surgical interventions, and without any sign of progression in corneal diameter, axial length, or optic disc cupping and without visual devastating complications. The mean±SD age at presentation and at the surgery of the study children was 3.63±1.74 and 55.23±1.60 days, respectively. The mean±SD IOP and cup/disc ratio of all study eyes at presentation and at final follow-up were 34.91±0.82mmHg and 0.70±0.09 and 17.04±0.74mmHg and 0.63±0.08, respectively. Complete success was achieved in 54.5%, 43.5%, and 31.6% in the VCST, DEVT, and SEVT groups, respectively. A self-limited hyphema was the commonest complication in all groups. Angle procedures are safe and marginally effective for the surgical treatment of neonatal-onset PCG, bringing IOP under control for at least 4 years of follow-up. Circumferential trabeculotomy as a first-line treatment has more favorable outcomes than rigid-probe SEVT. Rigid-probe viscotrabeculotomy offers an alternative to the noncompleted circumferential procedure.

Glaucoma in pregnant women: features of treatment

This review provides information on the features, incidence, pathogenetic mechanism, possibilities of conservative, laser and surgical treatment of glaucoma in pregnant women. The purpose of this literature review is to study the features of managing patients with glaucoma during pregnancy. Glaucoma is a large group of eye diseases characterized by a gradual development of visual impairments and atrophy of the optic nerve. The pathology is most common among the population over 40 years old, but due to the advancement of reproductive technologies, the availability of diagnostic methods, as well as high clinical awareness, the frequency of ophthalmologists managing glaucoma in pregnant women increases. Elevated intraocular pressure in pregnant women is becoming more common and, therefore, is an urgent problem. There is a trend towards an increase in the number of pregnant women who experienced elevated intraocular pressure for the first time. Previously identified pathology in childhood or secondary glaucoma due to previous ophthalmic diseases or severe somatic pathology is a special category of patients. Such patients are encountered regularly and require close supervision by both an ophthalmologist and a gynecologist. The evidence base for antiglaucoma drugs is small; there are clinical experiments on animals, which results do not always carry over to humans, and retrospective studies. The doctor's arsenal presently includes a number of drugs that have possible side effects for the fetus, as well as laser and surgical treatment. There is no standard treatment, so each case should be considered individually with an understanding of the physiology, mechanism of action of the drugs and their possible effects. Therefore, glaucoma during pregnancy and lactation is a serious medical problem, and its solution depends on interdisciplinary medical approach.

The impact of childhood glaucoma on psychosocial functioning and quality of life: a review of the literature.

We present a novel comprehensive literature review of studies of the psychosocial functioning (PF) and quality of life (QoL) of patients with childhood glaucoma and their caregivers. Our findings demonstrate variable study quality and approach, as well as inconsistent results relating to the association of glaucoma-specific factors and sociodemographic variables with measured PF and QoL. Future studies should focus on the development of culturally cognizant and standardized assessment tools, execution of multi-center longitudinal studies with global representation, evaluation of PF and QoL among siblings and childhood glaucoma providers, and implementation of interventions to improve patient and caregiver PF and QoL.

Current surgical techniques for the management of pediatric glaucoma: A literature review.

Pediatric glaucoma surgery is challenging due to its diverse and complex pathophysiology, altered anterior segment anatomy, greater potential for failure, and complications compared to adult patients. Moreover, numerous challenges are associated with long-term postoperative management. Thus, when dealing with childhood glaucoma, it is important to consider the potential complications in addition to the benefits of each intervention. The purpose of this article is to review recently published literature to shed light on the most recent surgical techniques for the safe and effective treatment of childhood glaucoma. Current literature shows that goniotomy and trabeculotomy are the first choices for the management of primary congenital glaucoma. Although older children with phakic eyes seem to benefit from trabeculectomy with adjunctive mitomycin C, it carries a long-term risk of bleb-related endophthalmitis. Glaucoma drainage devices may be preferred for patients with secondary or refractory glaucoma. However, hypotony or tube-related complications are common and encountered more often in children than in adults. Cyclodestructive procedures are also an option for cases in which filtering surgery has failed, but they can also be used as a temporizing measure to reduce the rate of complications in high-risk patients. However, their outcomes can be unpredictable, in terms of efficiency and complications. Finally, minimally invasive glaucoma surgery (MIGS) as the sole alternative treatment or as an adjunctive surgical procedure is a relatively new path for pediatric patients.

The PAUL® glaucoma implant: 1-year results of a novel glaucoma drainage device in a paediatric cohort.

The PAUL® glaucoma implant (PGI) is a novel glaucoma drainage device, which has not been previously reported in paediatric glaucoma management. This study aims to evaluate the safety and effectiveness of the PGI in a paediatric cohort. A retrospective evaluation of 25 cases of paediatric PGI surgery (age 8months to 16years) wasperformed at Manchester Royal Eye Hospital between September 2019 and July 2020. Primary outcome measures included failure (intraocular pressure (IOP) > 21mmHg or < 20% reduction of IOP, removal of the implant, further glaucoma intervention or visual loss. Secondary outcomes included mean IOP, mean number of medications, logMAR visual acuity and complications. Eleven eyes (48%) had a complete success and achieved an unmedicated IOP < 21mmHg, and 21 eyes (84%) had a qualified success (with or without medications). Four failures were observed, 2 due to hypotony and 2 underwent further surgery (gonioscopy-assisted transluminal trabeculotomy). The mean preop IOP was 30.9 ± 5.9mmHg (n = 25), falling to 13.5 ± 6.8mmHg at 1month, 17.9 ± 7.2mmHg at 3months, 13.4 ± 5.1mmHg at 6months, 13.2 ± 4.9mmHg at 12months and 11.8 ± 4.6mmHg at 24months. The mean change in IOP from the preoperative visit to the last visit was a reduction of 19.1 ± 7.7mmHg. A significant reduction in the number of medications and IOP was demonstrated after PGI (p < 0.0001). Nine patients required removal of the intraluminal Prolene stent from the PGI for further pressure lowering. The one- to two-year results demonstrate paediatric PGI has high qualified success rates and effectively reduces IOP and the need for glaucoma medical therapy.

Endothelin-1 level in the tear fluid of children with primary congenital glaucoma

Purpose. To analyze the level of endothelin-1 (ET-1) in the tear fluid (TF) of children with primary congenital glaucoma (PCG) and to detect possible correlations between the clinical and the laboratory data. Material and methods. We examined 23 eyes of 15 children with PCG aged between 7 months and 15 years and 3 healthy fellow eyes of these children. 25 eyes of children of same age without glaucoma (somatically healthy with mild hyperopia and/or concomitant strabismus) served as control. A standard ophthalmological examination was supplemented by the flash visual evoked cortical potential, a total and a rhythmic electroretinogram, axial length (AL) echobiometry of the eye, optical coherence tomography of the optic nerve head, enzyme immunoassay (ELISA) of ET-1 level in TF were given. Results. In most children with PCG (95.6 %), the TF level of ET-1 (mean 9.69 ± 3.80 pg/ml) was higher than that in healthy children (4.65 ± 2,02 pg/ml) (p &lt; 0.001). Increased levels of ET-1 (up to 8.90 pg/ml) were also detected in healthy fellow eyes of children with PCG. The mean level of ET-1 in children with PCG aged 3 to 15 years was significantly higher (p&lt; 0.05) lower than in the initial stage. Our study revealed no correlations between the ET-1 level and the degree of retinal nerve fiber layer thinning, or the AL in children with PCG. Conclusion. For the first time, an increased level of ET-1 in the TF in children with PCG was revealed as compared to healthy children. A lower value of ET-1 in the far advanced PCG stage as compared to the initial stage can be explained by long-term chronic eye tissue hypoxia depleting the protective reserves of the eye. Since no obvious correlation between ET-1 level in the TF and clinical and functional data of children with PVG has been found, we cannot definitely view the ET-1 level in the TF as a measure of ischemia degree in PCG. Further studies are needed to obtain reliable correlations.

Recent outbreak of zika virus in India amid ongoing COVID-19 and monkeypox outbreak: A call for action.

Recent outbreak of zika virus in India amid ongoing COVID-19 and monkeypox outbreak: A call for action.

Clinical features of early-onset pediatric traumatic glaucoma and predictive factors for the need of early glaucoma surgery.

To assess the clinical presentation of pediatric patients having early traumatic glaucoma and to analyze early predictors for the need of filtration surgery. Patients with early traumatic glaucoma after close globe injury (CGI) from January 2014 to December 2020 were retrospectively reviewed. Clinical features, treatment provided (medical and surgical), and visual outcomes were documented. Patients were divided into two groups based on the management required: group A- trabeculectomy and group B- medication + minor surgery. A total of 85 patients were studied after applying the necessary inclusion and exclusion criteria. Out of these, 46 underwent trabeculectomy for the control of intraocular pressure (IOP) and the remaining 39 were managed with antiglaucoma medications. Significant male predominance of 9.6:1 was observed. Patients presented to the hospital after a mean duration of 8.5 days posttrauma. Wooden objects were most commonly responsible for trauma. Mean best corrected visual acuity at presentation was 1.91 log of minimum angle of resolution (logMAR). Mean IOP at presentation was 40 mmHg. The common anterior segment finding were severe anterior chamber (AC) reaction (63.5%), followed by angle recession (56.4%). Severe AC reaction (P = 0.0001) and corneal microcystic edema (P = 0.04) were significant predictive factors for early need of trabeculectomy. Need of trabeculectomy was higher in patients with severe AC reaction and corneal microcystic edema. The threshold to perform trabeculectomy should be lower, as glaucoma is often relentless, severe, and may result in irreversible vision loss.

Outcomes of Non-Penetrating Deep Sclerectomy for Primary Congenital Glaucoma Performed by Experienced versus Trainee Surgeons: A Cohort Study.

To compare the outcomes of non-penetrating deep sclerectomy (NPDS) for primary congenital glaucoma (PCG) performed by experienced vs trainee surgeons. This retrospective cohort study was conducted in 2022 in Saudi Arabia. Consultants (Gr-1) and trainee pediatric ophthalmologists (Gr-2) performed NPDS on pediatric patients with PCG. Success was defined as an intraocular pressure (IOP) less than 21 mmHg at 6 months after surgery. Complications, glaucoma medications, and additional procedures were also observed in the two groups. Gr-1 and Gr-2 operated on 14 and 39 eyes with PCG, respectively. The absolute success rates were 90.9% (95% confidence interval [CI]: 73.9, 100) in Gr-1 and 96.7% (95% CI: 90.2, 100) in Gr-2 (odds Ratio=1.1; 95% CI: 0.87, 1.3; P=0.54). Survival analysis suggested that the failure rate in the first 6 months after NPDS was not significantly different between the two groups (hazard ratio=1.45; 95% CI: 0.13, 16.0; P=0.767). The complications included hypotony (2 cases), vitreous hemorrhage (1 case), and total flap penetration (1 case). Only one eye in Gr-2 needed glaucoma medication after surgery. There was no significant difference in the success rates of one surgeon before and after training (P=0.43). The age (P=0.59) and sex (P=0.77) of patients, type of surgeon (P=0.94), and preoperative IOP (P=0.59) were not significant predictors of a stable IOP at 6 months after NPDS. At 6 months after NPDS surgery performed by experienced and trainee pediatric ophthalmologists, the outcomes (stabilization of IOP) were similar between the two groups.

Efficacy and Safety of Gonioscopy-Assisted Transluminal Trabeculotomy for Primary Congenital Glaucoma.

Gonioscopy-assisted transluminal trabeculotomy (GATT) provided effective intraocular pressure (IOP) control in primary congenital glaucoma (PCG). Also, approximately two third of patients did not need antiglaucoma medication at an average follow-up of 1 year after surgery. The purpose of this study was to assess the safety and efficacy of GATT surgery in eyes with PCG. This study is a retrospective review of patients who underwent GATT surgery for PCG. Outcome measures were changes in IOP and number of medications at all time points (1, 3, 6, 9, 12, 18, 24, and 36mo after surgery), and success rates. Success was defined as IOP<21mmHg with at least a 30% reduction from the baseline, complete if without medications, or qualified if with or without medications. Cumulative success probabilities were analyzed using the Kaplan-Meier survival analyses. Twenty-two eyes of 14 patients diagnosed with PCG were enrolled in this study. The mean IOP reduction was 13.1mmHg (57.7%) with a mean decrease of 2 glaucoma medications at the final follow-up. All mean IOP readings during postoperative follow-up were significantly lower than baseline ( P <0.05 for all). Cumulative probability of qualified success was 95.5% and the cumulative probability of complete success was 66.7%. GATT was safe and successfully lowered IOP in patients with PCG with the advantage of avoiding conjunctival and scleral incisions.

Glaucoma in infancy and childhood

Glaucoma in infancy and childhood is arare disease. An immediate diagnosis and treatment are absolutely necessary to prevent blindness of affected children. Childhood glaucoma is characterized by aheterogeneous phenotype: besides primary congenital glaucoma, secondary types often exist and the individualized treatment requires an experienced interdisciplinary team. The pathogenesis is not always discernible and genetic alterations sometimes cause the disease. Asurgical procedure is usually necessary to lower the intraocular pressure. Refractive and orthoptic care are equally important to avoid amblyopia. This article gives an overview of childhood glaucoma and outlines the most important diagnostic and therapeutic aspects.