Glaucoma In Children Research Articles

Glaucoma-Protective Human Single-Nucleotide Polymorphism in the Angpt2 Locus Increased ANGPT2 Expression and Schlemm Canal Area in Mice-Brief Report.

The ANGPT (angiopoietin)-TEK (tyrosine kinase, endothelial) vascular signaling pathway plays a key role in the formation of Schlemm canal, and loss-of-function mutations in the TEK or ANGPT1 gene are associated with primary congenital glaucoma in children. In genome-wide association studies, an association was identified between protection from primary open-angle glaucoma and the single-nucleotide polymorphism rs76020419 (G>T), located within a predicted miR-145-binding site in the 3' untranslated region of ANGPT2. To date, the functional impact of this variant in the anterior chamber of the eye remains largely unexplored. MT (mutant) mice harboring an orthologous rs76020419 minor allele (T) were generated using CRISPR/Cas9 (clustered regularly interspaced short palindromic repeats/clustered regularly interspaced short palindromic repeat-associated 9). Plasma and tissue samples, including eyes, were collected, and ANGPT2 expression was quantified using ELISA. Anterior segments from eyes were collected from WT (wild-type) and MT mice, and Schlemm canal area was quantified. In the MT group, higher ANGPT2 concentrations were observed in the plasma, lungs, kidneys, and eyes (P=0.0212, P<0.001, P=0.0815, and P=0.0215, respectively). Additionally, the Schlemm canal was larger in MT mice compared with WT mice (P=0.0430). The rs76020419 minor allele (T) is associated with increased levels of ANGPT2 and a larger Schlemm canal in mice. These findings suggest a potential protective mechanism in glaucoma.

Comparing glaucoma risk in children receiving low-dose and high-dose glucocorticoid treatment after cataract surgery.

Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic-pituitary-adrenal axis suppression. We wish to compare glaucoma outcomes following high-dose and low-dose glucocorticoid treatment after paediatric cataract surgery. This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High-dose treatment included 0.5-1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6-8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low-dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups. Overall, 267 children (388 eyes) were included in the study. Ninety-five children (133 eyes) had received high-dose treatment and had a median follow-up time of 89 months (IQR: 57.2-107.4), while 173 children (255 eyes) had received the low-dose treatment and had a median follow-up time of 40.5 months (IQR: 22.9-60.4). Survival curves showed a lower risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm. Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High-dose glucocorticoid should be limited in children undergoing cataract surgery.

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

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

Комбинированное оперативное вмешательство при врожденных глаукомах у детей с сочетанной патологией хрусталика

In recent years, the percentage of early manifestations of congenital glaucoma in children with anomalies of the anterior segment of the eye has increased. The tactics of surgical treatment of this form of glaucoma, especially with combined pathology of the lens, is an urgent problem in pediatric ophthalmic surgery. Purpose. To determine the optimal tactics and analyze the results of surgical treatment of congenital glaucoma in eyes with anomalies of the anterior segment of the eye, combined with abnormalities of the lens development. Material and methods. For 2018–2023 we operated on 27 people (43 eyes) with congenital glaucoma in eyes with concomitant congenital lens pathology. All children underwent combined surgical interventions (vitreal and anthralaucomatous surgery) in one or more stages. Results. As a result of surgical treatment, a positive effect on IOP compensation was achieved in 88,4 % of cases (38 eyes). Conclusions. In case of pathology of the anterior segment of the eye in combination with pathology of the lens, surgical intervention is necessary in the early stages of identifying Intraocular pressure decompensation. Сombined operations are effective: vitreal surgery (reconstructive surgery on the anterior segment) and antiglaucomatous operations of the fistulizing type. Keywords: congenital glaucoma, congenital lens pathology, combined operations

Silent Progressive Glaucoma in Encephalofacial angiomatosis (Sturge-Weber Syndrome): A Vision-Preserving Trabeculectomy

Introduction : Encephalofacial angiomatosis, also known as Sturge-Weber Syndrome (SWS), is a rare, non- hereditary condition affecting multiple organs. Glaucoma occurs in almost 70% SWS children, more commonly when the port-wine stain involves the upper eyelid skin. Secondary glaucoma was present due to elevated venous pressure.&#x0D; Case Illustration : An 8-year-old boy with typical port-wine stain involving eyelid, came with recurrent painful right eye (RE) and headache in the past 3 months. He was diagnosed with SWS at 1 year and was on daily doses of carbamazepine and valproic acid for seizure control. His best visual acuity and intraocular pressure were 0.5/60 RE, 6/38 LE, 38 mmHg RE, 28 mmHg LE, respectively. Examination revealed Cup-disc-ratio (CDR) 0.9-1.0 RE and 0.5-0.6 LE. During the first three months, he showed favourable outcome with timolol and latanoprost (controlled IOP with target of &lt;12 mmHg and markedly similar Cup-Disc Ratio). However, at 4th and 5th month visit, his IOP significantly increased despite of additional regiments, thus underwent trabeculectomy on both eyes for preserving his sight. After procedure, his IOP remained stable &lt;12mmHg with maintained bleb, deep anterior chamber, also attached posterior segment.&#x0D; Discussion : Treatments of secondary glaucoma of SWS typically involved surgery with significantly lower success rate compared to Primary Congenital Glaucoma. Trabeculectomy or tube shunt surgery should be performed with caution due to risks of choroidal effusion and hemorrhages.&#x0D; Conclusion : Secondary glaucoma in children with SWS is common and challenging. Trabeculectomy should be pursued when the benefit outweighs the risks, even with a slim chance, to preserve the vision.

ALGORITHM FOR MANAGEMENT OF CHILDREN AFTER ANTI-GLAUCOMATOSUS SURGERY

The prevalence of glaucoma in children is 1:10000-1:12000. In the structure of blindness in children, the proportion of thepathology under consideration ranges from 2 to 15 %.The goal of surgical treatment of glaucoma is to achieve the target elevated intraocular pressure (IOP) without the use of medications. Early complications include shallow anterior chamber syndrome, hyphema, ciliochoroidal detachment, excessive hypotension and hypertension. The probability of these complications is quite high: according to some data it can reach 50 %, which shows the relevance of this problem.Aims. To study the frequency and nature of early postoperative complications and to analyze the results of treatment inchildren with primary congenital glaucoma.Material and methods. The total number of children was 50 (91 eyes) who underwent anti-glaucomatous surgery and earlypostoperative complications were revealed.Results. Analysis of the structure of early postoperative complications after anti-glaucoma surgery showed that on thefi rst day, the total number of patients with complications was 61.54 %. On the third day, the total number of patients withcomplications decreased to 39.56 %. Of these patients, the largest number were patients with hypotension with CCO 32.97 %, hyphema was –19.78 % in the early postoperative period and ophthalmohypertension was –17.58 %.On the seventh day, the number of complications was 9.9 % of patients who were recommended to continue conservative treatment in inpatient conditions.Conclusion. In the early postoperative period after conservative treatment, the number of complications decreased to 90.1 %. None of these patients required repeat surgery. Patients were discharged home under the supervision of a local ophthalmologist.

OPTIMIZATION OF THE METHOD OF SURGICAL TREATMENT OF PRIMARY INFANTILE CONGENITAL GLAUCOMA IN CHILDREN

Pediatric glaucoma is a term that encompasses several forms of congenital glaucoma and types of secondary glaucoma thatdiff er in etiology, pathogenesis, and clinical presentation. Surgical treatment is the main method of IOP reduction in pediatricglaucoma. To date, no uniform method of surgical treatment of infantile glaucoma has been proposed, which makes the searchfor adequate methods of surgical intervention in this pathology most urgent.The aim of this work was to evaluate the effi cacy of surgical treatment of primary congenital infantile glaucoma in children.Material and methods. In the eye department of the clinic of the Tashkent Pediatric Medical Institute, the eff ectiveness of themethod of surgical intervention in children from 3 to 10 years old with primary congenital infantile glaucoma was evaluated.Examined – 20 patients (40 eyes). Of these, 5 patients (10 eyes) entered the advanced stage, 10 patients (20 eyes) entered the far advanced stage, and 5 patients (10 eyes) entered the terminal stage, respectively. The patients underwent standard ophthalmological examination. The state of the optic nerve was investigated by optical coherence tomography Stratus OCT-3000 (Carl Zeiss Meditec), the visual fi elds – in 10 (20 eyes) patients aged over 8 years using standard automated and computer perimetry (SAP).Conclusions of the bioethical commission: This article evaluates the eff ectiveness of the method of surgical treatment ofprimary congenital infantile glaucoma in children. And gives specifi c results of diff erent operations at diff erent stages of primary congenital infantile glaucoma. Surgical treatment was chosen according to the degree of goniodysgenesis and the stage of the disease, which showed a satisfactory result in stabilizing the glaucoma process.Statistical analysis method using Microsoft Excel and SPSS programs was used for processing the results of theophthalmological study. Diff erences between the mean values (M±σ) were considered reliable at P≤0.05.Results and Discussion. All patients underwent surgical treatment, depending on the severity of morphometric changesin the anterior chamber angle, and in the postoperative period with an interval of 6 months – a course of neuroprotectivetherapy. According to the examinations, children with primary infantile glaucoma in advanced stage underwent non-penetrating deep sclerectomy in 10 eyes, with extensive – in 20 eyes and with terminal – in 10 eyes – sinusotrabeculotomy ab externo, sinusotrabeculectomy. In 2 eyes in the terminal stage, fi ltering surgery was performed according to the proposed method. Thus, the above methods of surgery reduce the number of intra- and postoperative complications by 12.5%, avoid reoperations, reduce IOP in 12.3% of cases, increase visual acuity by 0.15 compared to the original.Conclusion. The above methods of surgical treatment were chosen according to the degree of goniodisgenesis and the stageof the disease, which showed a satisfactory result in stabilizing the glaucoma process

Incidence of cataract and glaucoma in children with nephrotic syndrome undergoing steroid treatment

Background Nephrotic syndrome (NS) is by far, the most common glomerular disease in childhood period and is considered as one of the main aetiologies of child exposure to systemic steroids. High-dose corticosteroids for NS, are usually prescribed by pediatrians for a long period. Posterior subcapsular cataract (PSC) and increased intraocular pressure (IOP) are the two most common ocular complications associated with steroid treatment. The exact incidence, prevalence, severity, and time of cataract and glaucoma onset in those childrens have not yet been thoroughly investigated. Aim Evaluating the incidence of cataract and glaucoma in children with NS receiving steroid treatment during and after treatment cessation. Patients and methods This cohort prospective study was done at the Pediatric Nephrology Clinic at Zagazig University Children’s Hospital in co-operation with the Department of Ophthalmology, Zagazig University, for detailed eye examination. Totally 48 children with primary NS who received corticosteroids either as a single treatment or with other treatment modalities for more than 3 months were included in our study. Clinical features plus laboratory tests confirmed by renal biopsy were the main parameters used in the diagnosis of NS. Results Posterior subcapsular cataracts (PSC) were observed in 14 patients (29.2%). All studied patients had normal intraocular pressure ranging between 10 and 20 mmHg in both eyes during the follow-up period with no glaucomatous optic disc changes observed. Conclusion A significant number of children with NS treated with steroids are liable to develop cataracts and glaucoma that may progress and need surgery to preserve vision, so they have to be well diagnosed and followed-up.

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.

Goniotomy for Non-Infectious Uveitic Glaucoma in Children

Secondary glaucoma is still a blinding complication in childhood uveitis, for which most commonly used surgical interventions (trabeculectomy or glaucoma drainage implant) involve multiple re-interventions and/or complications postoperatively. The goniotomy procedure has never been investigated in the current era, in which patients with pediatric uveitis receive biologics as immunosuppressive therapy for a prolonged period, with potential implications for the outcome. The purpose of the study is to evaluate the efficacy and safety of a goniotomy procedure in pediatric non-infectious uveitis in a retrospective, multicenter case series. The primary outcomes were the postoperative intraocular pressure (IOP), number of IOP-lowering medications, and success rate. Postoperative success was defined as 6 ≤ IOP ≤ 21 mmHg, without major complications or re-interventions. Fifteen eyes of ten children were included. Median age of the included patients at goniotomy was 7 years; median follow-up was 59 months. Median (interquartile range) IOP before surgery was 30 (26-34) mmHg with 4 (3-4) IOP-lowering medications. At 1, 2, and 5 years after goniotomy, median IOP was 15, 14, and 15 mmHg with 2 (0-2), 1 (0-2), and 0 (0-2) medications, respectively (p < 0.001 postoperatively versus preoperatively for all timepoints). Success rate was 100%, 93%, and 80% after 1, 2, and 5 years, respectively. There were no significant changes in visual acuity and uveitis activity or its treatment, and there were no major complications. Our results show that the goniotomy is an effective and safe surgery for children with uveitic glaucoma.

Clinical outcomes in children and adolescents referred for increased cup:disk ratio at a tertiary referral center

To report clinical outcomes and risk factors for glaucoma in children and adolescents referred for increased cup:disk ratios (CDRs) to a tertiary referral center. This retrospective, single-center study examined all pediatric patients evaluated for increased CDR at Wills Eye Hospital. Patients who had previous known ocular disease were excluded. Demographic data, including sex, age, and race/ethnicity were recorded, as were baseline and follow-up ophthalmic examination findings, including intraocular pressure (IOP), CDR, diurnal curve, gonioscopy findings, and refractive error. Risks of glaucoma diagnosis based on these data were analyzed. A total of 167 patients were included, of whom 6 were found to have glaucoma. Despite more than 2 years' follow-up on 61 patients, all glaucoma patients were identified within the first 3 months of evaluation. Baseline IOP was statistically significantly higher in glaucomatous patients than nonglaucomatous patients (28 ± 7 vs 15 ± 4, resp. [P = 0.0002]), as was maximum IOP on diurnal curve (24 ± 3 vs 17 ± 3 [P = 0.0005]). In our study cohort, diagnosis of glaucoma was apparent in the first year of evaluation. Baseline IOP and maximal IOP on diurnal curve were found to be statistically significantly associated with glaucoma diagnosis in pediatric patients referred for increased CDR.

Вторичная афакическая глаукома у детей: 15-летнее ретроспективное исследование

Aim: to assess the incidence of glaucoma in children who underwent congenital cataract surgery, to determine the risk factors for its development. Patients and Methods: this retrospective study included 206 children (301 eyes) aged 10 years or less who underwent congenital cataract surgery in the Ophthalmology Department of St. Petersburg State Pediatric Medical University (SPbGPMU) with an average follow-up period of 8.8±0.2 years. The children were divided into 4 groups by age at the surgical procedure. Group 1 included children operated on at the age of 90 days and younger; group 2 — aged from 91 to 365 days; group 3 — from 1 year to 4 years 11 months 29 days old; group 4 — from 5 to 10 years old. Co-existing ocular disorders were present in 247 (82,1%) eyes. Co-occurring extraocular disorders were found in 52 (25,2%) of 206 operated patients. Results: by the last visit, no patient in group 4 developed glaucoma. Glaucoma was diagnosed in 21 eyes (27.3%) of 14 patients from group 1, in 16 eyes (21.1%) of 12 patients from group 2 and in 10 eyes (12.5%) of 8 patients from group 3. In 57.4% of cases, glaucoma was controlled with medications, and surgery was performed on 20 eyes, including sinus trabeculectomy and Ahmed valve implantation. Statistically significant risk factors for the development of secondary glaucoma encompassed cataract extraction in children younger than 1 year of age, microcornea, additional intraocular surgical interventions, and aphakia. Conclusion: a less effective visual outcome of aphakic glaucoma treatment is caused by multiple factors, including amblyopia, nystagmus, as well as delayed diagnosis and untimely surgical intervention. Thus, to ensure early diagnosis of glaucoma, it is necessary to put tonometry and measurement of the axial length of the eye on the list of diagnostic tools for the outpatient follow-up of patients who underwent congenital cataract surgery. Keywords: aphakic glaucoma, congenital cataract, Ahmed valve, Cataract extraction, microcornea, aphakia, intraocular surgical interventions. For citation: Sadovnikova N.N., Brzhesky V.V., Zertsalova M.A., Baranov A.Yu. Secondary aphakic glaucoma in children: a 15-year retrospective study. Russian Journal of Clinical Ophthalmology. 2023;23(2):80–85 (in Russ.). DOI: 10.32364/2311-7729-2023-23-2-80-85.

A comparative analysis of surgical outcome in uveitic and non-uveitic steroid-induced glaucoma in children.

To compare outcomes of surgical management of uveitic glaucoma (UG) and steroid-induced glaucoma (SIG) in children in terms of intraocular pressure (IOP) control, visual acuity, and associations for failure. This was a retrospective case-control study of consecutive UG (cases) and non-uveitic SIG (controls) in children <18 years of age who underwent surgery between January 2005 and December 2017. Primary trabeculectomy with mitomycin C (MMC) was performed in 12 cases (mean age: 9.2 ± 4.3 years) and 40 controls (mean age: 10.4 ± 3.7 years) (P = 0.33). Primary phaco-trabeculectomy with MMC was performed in 11 cases (mean age: 11.4 ± 4.7 years) and 16 controls (mean age: 10.4 ± 3.4 years) (P = 0.57). IOP control (P = 0.26), visual acuity (P = 0.97), number of glaucoma medications (P = 0.06), and survival rates (49% cases vs. 68% controls at 5 years; P = 0.22) were similar between the two groups following trabeculectomy. Survival rates in the phaco-trabeculectomy group at 5 years were 68% cases vs. 69% controls (P = 0.71). IOP was higher (P = 0.008) and visual acuity was worse (P = 0.02) in cases at the last visit. Associations for failure (univariate analysis) were younger age (OR: 6.29, 95% CL: 1.43, 27.67; P = 0.03) and male gender (OR: 4.79, 95% CL: 1.09, 20.97; P = 0.04). On multivariate analysis, younger age (OR: 11.985, 95% CL: 1.071, 134.153; P = 0.04) remained significant. Preoperative number of uveitic attacks was protective on univariate (OR: 0.75, 95% CL: 0.48, 1.15; P = 0.1) and multivariate analyses (OR: 0.49, 95% CL: 0.24, 0.09; P = 0.04). Outcomes of trabeculectomy between cases and controls were similar in our series. However, phaco-trabeculectomy in pediatric uveitic eye group fared worse than eyes with SIG.

Commentary: Surgical outcomes in uveitic glaucoma and steroid-induced glaucoma in children: Between the two evils.

Commentary: Surgical outcomes in uveitic glaucoma and steroid-induced glaucoma in children: Between the two evils.

Immediate results of micropulse cyclophotocoagulation in glaucoma in children

AIM: This study aimed to investigate the efficacy and safety of micropulse cyclophotocoagulation (MP-CPC) in the treatment of various types of glaucoma in children.&#x0D; MATERIAL AND METHODS: The study included 14 children (15 eyes) with uncompensated glaucoma of various etiologies, who underwent MP-CPC using the Cyclo G6 laser system (IRIDEX, USA). The intervention was considered absolutely effective when IOP reached 8 to 25 mm Hg without medications and without signs of progression of glaucoma, relatively effective, when the same criteria are achieved with hypotensive medications.&#x0D; RESULTS: The average age of children at the time of intervention was 8.51.5 yr (from 7 months to 17 yr). The average level of IOP before surgery was 28.51.1 mm Hg, 3 days after MP-CPC (18.871.04 mm Hg), while the absolute efficiency was 14.3%, relative 100%. By the end of the observation period (16 months; on average, 2.50.4 months), the average IOP was 24.41.31 mm Hg (average decrease, 14.3%), with absolute efficiency of 0% and relative of 66.7%. The average number of hypotensive medications received in instillations did not change significantly before and after MP-CPC and amounted to 3.450.22 and 2.910.39, respectively (p=0.167). Complications after MP-CPC were detected in six eyes (40%); in all cases, the appearance or increase of the inflammatory reaction in the anterior chamber was observed. In addition, in two eyes (13.3%). In addition, a slight mydriasis (45 mm) developed.&#x0D; CONCLUSION: MP-CPC is a safe and effective treatment for glaucoma in children with various etiologies. Further research is needed to evaluate the effectiveness of intervention in the long term and the safety of repeated procedures to achieve normal IOP and to develop individual schemes of MP-CPC.

Effectiveness of trans-scleral cyclophotocoagulation for refractory paediatric glaucoma

Background: The aim of this study was to find out the effectiveness of trans-scleral cyclophotocoagulation in lowering intraocular pressure in the paediatric population.Patients and methods: This quasi-experimental study was conducted between July 2020 and January 2021 in Department of Ophthalmology, The Children’s Hospital, Lahore. Total 45 eyes of 42 children of age 1-14 years, both genders, with glaucoma were enrolled in this study. Diode cyclophotocoagulation unit and probe of make Quantel Medical was used for cycloablation under general anesthesia. Postoperative intraocular pressure was noted by using handheld Perkins applanation tonometer Mk2 after every 3 weeks for 12 weeks. If an IOP of ≤21mmHg was achieved, then efficacy or success was labeled. Patients with an IOP of &gt;21mmHg after 12 weeks were selected for repeat cycloablation treatment. Failure was labeled to an IOP of &gt;21mmHg even after a repeat session. Data analysis was done using SPSS 24. Results: In this study, 45 eyes were included with a mean age of 4.49 ± 3.12 years. There were 21 (46.7%) males and 24 (53.3%) females. At the time of presentation, the most common diagnosis was primary congenital glaucoma [28 (62.2%)], followed by aphakic glaucoma [10 (22%)], Anterior segment dysgenesis [2 (4.4%)], Pseudophakic glaucoma [2 (4.4%)], Sturge weber syndrome [2 (4.4%)] and Post-traumatic [1 (2.2%)]. The mean IOP at baseline was 26.67±3.66 mmHg, which was reduced to 19.60±6.33 mmHg with mean change in IOP of 7.07±4.56 mmHg (p&lt;0.05). The mean anti-glaucoma drugs used at baseline was 2.91±0.42, which was reduced to 0.93±1.2 with mean change in use of anti-glaucoma drugs of 1.98±1.06 (p&lt;0.05). Success was achieved in 34 (75.56%) eyes, while 11 (24.44%) needed second session. After repeat session 2 (4.4%) eyes went into treatment failure.Conclusion: Diode cyclophotocoagulation is a useful therapy for the management of glaucoma in children.

Genetic variants of congenital glaucoma. Analysis of the literature and description of the clinical case

Purpose. Description of a clinical case of a patient with congenital glaucoma and mutations in the CYP1B1 gene, taking into account the analysis of literature data.Material and methods. The following methods were used to examine the patient: standard ophthalmological examination, EPI (VEP for flash, mERG and rERG) and fundus photoregistration, molecular genetics study of the CYP1B1 gene. DNA research was carried out by the method of direct automatic sequencing according to Sanger (the biomaterial was used — venous blood).Results. The article describes a clinical case of congenital glaucoma in a child with an early (from birth) manifestation of glaucoma, a distant stage at the time of examination, at the age of 2 years 6 months. Revealed pronounced clinical, functional and structural changes in the eyes, as well as changes in electrophysiological parameters. The previously described pathogenic variants of the nucleotide sequence 1330C&gt; T (p.Arg444 *) and c.1405C&gt; T (Arg469Trp) in heterozygous states were found in the CYP1B1 gene.Conclusion. The severity of the clinical course of congenital glaucoma in the described clinical case is presumably due to mutations in the CYP1B1 gene. A timely, interdisciplinary approach to diagnosis is key to successful treatment of glaucoma in children.

Management of Uveitic Glaucoma in Children with Blau syndrome

Pendahuluan: Glaukoma pada anak merupakan kondisi yang berpotensi menyebabkan kebutaan. Penatalaksanaan glaukoma uveitis sulit dan menantang karena banyak mekanisme yang terlibat dalam patogenesisnya. Tujuan: Untuk melaporkan karakteristik klinis dan penatalaksanaan glaukoma uveitis pada anak dengan sindrom Blau. Laporan Kasus: Anak laki-laki berusia 13 tahun datang ke Poliklinik Glaukoma RS Mata Cicendo dengan keluhan kedua mata buram sejak 4 tahun lalu. Pasien telah didiagnosis sebagai sindroma Blau. Keluhan disertai persendian bengkak di lengan dan lutut, kulit hipopigmentasi dan bersisik. Riwayat operasi trabekulektomi mata sebelah kiri. Pemeriksaan oftalmologi menunjukkan visus ODS 1/300, tekanan intraokular OD 34mmHg dan OS 40mmHg. Segmen anterior mata kanan terdapat keratopati pita, sinekia posterior 360o, sinekia anterior perifer, dan katarak. Pada mata kiri terdapat bleb pada konjungtiva bulbar, keratopati pita, sinekia posterior, iridektomi perifer, dan katarak. Pasien didiagnosis sebagai glaukoma uveitis ODS, sindrom Blau, katarak komplikata ODS, keratopati pita ODS. Pasien diterapi dengan tetes mata timolol maleat 0.5%, brinzolamide, metilprednisolon tablet, metotreksat pre operatif. Pasien menjalani trabekulektomi, 5FU, sinekiolisis, retraktor iris, membranektomi mata kanan. Satu tahun pasca operatif tekanan intraokular pasien terkontrol, OD: 19mmHg, OS: 28mmHg dengan pemberian tetes mata timolol maleat 0.5% dan brinzolamide. Kesimpulan: Tatalaksana glaukoma uveitis pada anak membutuhkan terapi multidisiplin yang agresif dalam mengontrol inflamasi, tekanan intraokular, dan terapi ambliopia untuk mempertahankan penglihatan.

Neovascular Glaucoma in Children: A case series and a review of the literature.

To study the uncommon causes and treatment options for neovascular glaucoma in children. A review of the literature on neovascular glaucoma in children was conducted and we present three cases of neovascular glaucoma in children. We present three cases of neovascular glaucoma: two cases were secondary to a retinal vasoproliferative tumor-one to neurofibromatosis type 1 and the other to exudative retinopathy secondary to mild retinopathy of prematurity-and one case was secondary to a central retina vein occlusion secondary to an optic nerve glioma. Vision in the affected eye was severely impaired in all the children. The diagnosis and treatment of neovascular glaucoma in children is challenging and often a complication of a systemic or late-stage ocular condition. An appropriate diagnosis and estimation of the visual potential are essential to determine the correct treatment, especially in young children.

Severe brimonidine eye drop intoxication in a neonate as an accidental oral ingestion

Brimonidine tartrate eye drops are a topical agent used to treat glaucoma in children over 2 years of age and adults. It is banned for children younger than 2 years of age because post-marketing studies have shown serious side effects. Colic is common in infants, which worries parents. And parents often use herbal and chemical medicines to solve this problem. We present a 12-day-old newborn with brimonidine eye drop intoxication, in which the drug was mistakenly administered orally to treat the colic problem.