Juvenile Open-angle Glaucoma Research Articles

Characteristics of Pediatric Glaucoma in a Latin American Reference Center.

ABSTRACTAimTo describe the clinical and epidemiological characteristics of children with pediatric glaucoma (PG) treated in an ophthalmologic national reference center.Materials and methodsA retrospective study of patients diagnosed with PG in a national ophthalmologic reference center was made, between 2005 and 2015. Clinical findings, type of treatment, and the follow-up were evaluated.ResultsA total of 89 patients (145 eyes) were included. The median age of diagnosis was 2.0 years. The most frequent type of glaucoma was primary PG with 67.4% of affected patients, primary congenital glaucoma (PCG) being more frequent (69 eyes) than juvenile open-angle glaucoma (JOAG 36 eyes). Secondary PG accounted for 32.6% of the cases (40 eyes). At least one surgical procedure was needed in 56.6% of all studied eyes, and 10.7% of eyes had more than two surgical procedures. Even more, eyes with PCG had surgery in 88.4% of cases. On the contrary, eyes with JOAG did not require surgery. In the last assessment, the distribution of cases according visual acuity did not show differences. However, it is important to note that patients with secondary PG maintained a good vision only in 17.9% of cases.ConclusionPediatric glaucoma is a heterogeneous group of diseases, and due to its low incidence, descriptive reports of large cohorts are not available. This study has a well-detailed report of PG characteristics in a national reference center. The frequency of JOAG in the present study was significantly higher than that reported in other studies. Also, clinical characteristics of all glaucoma described have some differences from data published.Clinical significanceThere are few studies that describe characteristics of PG. This study is an important tool to analyze the characteristics of PG in an effort to better know the disease.How to cite this articleSaavedra C, Rios HA, Belalcazar S, et al. Characteristics of Pediatric Glaucoma in a Latin American Reference Center. J Curr Glaucoma Pract 2020;14(1):10–15.

Rate of Complete Catheterization of Schlemm's Canal and Trabeculotomy Success in Primary and Secondary Childhood Glaucomas

Despite the increasing use of microcatheters to perform 360-degree trabeculotomy, the rate of complete Schlemm's canalization in different forms of pediatric glaucoma is under-reported. Retrospective institutional observational case series. Ocular diagnoses and surgical details of 60 pediatric patients (≤18 years old) who underwent trabeculotomy between 2013 and 2019 were collected. Surgical success was defined as an intraocular pressure (IOP) of 5-20mm Hg and no additional IOP-lowering surgery. Eighty-five eyes of 60 patients underwent trabeculotomy. For bilateral cases, the first eye to undergo surgery was included for analysis. Diagnoses included primary congenital glaucoma (PCG n= 22), juvenile open angle glaucoma (JOAG n= 16), glaucoma following cataract surgery (GFCS n= 15), and other secondary forms of glaucoma (n = 7). Canalization using a microcatheter was attempted in 52 of 60 eyes (87%) of which 21 (40%) achieved full 360-degree. Complete canalization was attained in 69% of JOAG patients, which was significantly higher than in PCG patients (22%; P= 0.007), but not GFCS (36%) and other secondary glaucoma (29%). The 5-year survival rate for all eyes was 75% with 95% confidence interval (CI), 57 to 86. Survival curves for 360-degree catheter, 270-degree to 360-degree combined catheter/Harms trabeculotome, and <180-degree Harms trabeculotome trabeculotomies were significantly different (P < 0.001) with 5-year survival rates of 100%, 69% with 95% CI, 16 to 93, and 48% with 95% CI, 29 to 64, respectively. A 360-degree catheter trabeculotomy is highly effective in obtaining IOP control; however, complete canalization of Schlemm's canal is most frequently achieved in JOAG patients. Congenital anomalies or scarring from previous surgeries, which prevents full canalization, may inherently decrease success of angle surgery in other glaucoma.

Microcatheter-assisted trabeculotomy for the treatment of juvenile open angle glaucoma

Objective To evaluate the efficacy of microcatheter-assisted trabeculotomy for the treatment of juvenile open angle glaucoma(JOAG). Methods Retrospective case cohort series study. Clinical datas of 20 eyes of 15 cases with JOAG treated with microcatheter-assisted trabeculotomy from Apr.2017 to May 2018 at Eye Hospital Affiliated to Chengdu University of T. C.M. were collected and analysed. Results The pre-operative IOP was (33.55±10.73) mmHg (1 mmHg=0.133 kPa). The post-operative IOP decreased to(15.55±3.88)mmHg at last follow-up, and the difference was statistically significant between before and after surgery (t=9.320, P=0.000). The kinds of anti-glaucoma drugs used before surgery were 3.25±0.55 and at the last follow-up decreased to 0.80±1.32 (Z=-3.750, P=0.001). The full success rate of the last follow-up was 70.00 %(14/20) and conditional success rate was 90.00%(18/20). No severe complication occurred intraoperative and psotoperative. Conclusion Microcatheter-assisted trabeculotomy is a safe and effective for the treatment of JOAG. Key words: Glaucoma, open angle, juvenile; Trabeculotomy, microcatheter-assisted; Pressure, intraocular

Real-life experience of using brinzolamide/brimonidine fixed drop combination in a tertiary glaucoma centre

PurposeTo investigate the intraocular pressure (IOP)-lowering efficacy and tolerance of brinzolamide/brimonidine fixed combination (BBFC) under real-life conditions in a tertiary glaucoma centre.MethodsMedical records of all ocular hypertensive and open-angle glaucoma patients (n = 52) treated with BBFC were retrospectively analysed.ResultsThirty-nine patients had primary open-angle, 6 exfoliative, 2 pigment, 1 normal tension and 1 juvenile open-angle glaucoma and 3 ocular hypertension. The prior therapy was a prostaglandin analogue (PG) (n = 4), PG/timolol (n = 20), PG/timolol and topical carbonic anhydrase inhibitor (CAI; n = 19), timolol/CAI (n = 1), PG and CAI (n = 4), timolol/pilocarpine and PG (n = 1), timolol/brimonidine and PG (n = 1) and timolol/brimonidine, PG and CAI (n = 2). These were simplified to PG/timolol and BBFC (n = 41), PG and BBFC (n = 9), timolol and BBFC (n = 1) and timolol/pilocarpine, PG and BBFC (n = 1). The IOP on the study eyes was 21.2 ± 3.7 mmHg before and 16.9 ± 2.6, 16.0 ± 2.2, 17.6 ± 3.1 and 18.0 ± 3.1 mmHg after the introduction of BBFC at month 1, 3, 6 and 12, respectively (p < 0.0003 for all time points compared to baseline, p = 1.0 for all other comparisons). Thirty-one patients (59.6%) experienced no adverse event, 17 (32.7%) reported ocular and 6 (11.5%) systemic adverse events. BBFC therapy was terminated on 27 patients (51.9%): on 19 (36.5%) due to adverse events and on 8 (15.4%) due to insufficient IOP reduction.ConclusionIn real-life practice, the introduction of BBCF allows significant and clinically meaningful IOP reduction and therapy simplification in glaucoma patients requiring complex medication, but in more than one third of the patients it is not tolerated due to adverse events.

Classifying juvenile onset primary open angle glaucoma using cluster analysis

AimTo classify unrelated patients with juvenile onset primary open angle glaucoma (JOAG) into clinically useful phenotypes using cluster analysis.MethodsOut of the 527 unrelated patients with JOAG, the study included 414...

Comparison of vessel density in eyes of children with juvenile open angle glaucoma and healthy age-matched controls: an optical coherence tomography angiography study

Comparison of vessel density in eyes of children with juvenile open angle glaucoma and healthy age-matched controls: an optical coherence tomography angiography study

Prevalence and Clinical Characteristics of Childhood Glaucoma at a Tertiary Care Children's Hospital.

Glaucoma suspect was the most prevalent category in this study followed by glaucoma associated with acquired ocular anomaly and juvenile open-angle glaucoma. Primary congenital glaucoma was diagnosed in only 3% of the population studied. To describe the prevalence and clinical characteristics of childhood glaucoma diagnosed over a 10-year period among patients aged 18 years or below who were seen at a tertiary care children's hospital using the new Childhood Glaucoma Research Network classification system. Medical records of all patients aged 18 years or below (n=108) who were diagnosed with glaucoma between January 1, 2008 through September 30, 2018 were reviewed. Data collected included demographics (age at diagnosis, sex, and family history of glaucoma), intraocular pressure, disc-to-cup ratio, retinal nerve fiber layer thickness, and refractive errors. Clinical characteristics of each patient were evaluated according to the criteria established by Childhood Glaucoma Research Network. Categorical distributional equivalence comparisons were performed using the Pearson χ test. A P-value <0.05 was defined as statistically significant. A total of 108 patients with a diagnosis of childhood glaucoma or glaucoma suspect were included in this study. Sixty-four percent of these patients were males (P<0.0001). The mean age at the time of diagnosis was 7.07±5.4 years. "Glaucoma suspect" was the most prevalent category (46%, P=0.0002), followed by glaucoma associated with the acquired ocular anomaly (20%) and juvenile open-angle glaucoma (16%). Primary congenital glaucoma represented 3% and all these patients were males. Sixty-nine percent of the patients had bilateral involvement (P=0.0073). The highest intraocular pressure recorded in the study was 57 mm Hg, the largest cup-to-disc ratio was 0.96, and the lowest retinal nerve fiber layer measurement was 39 μm. Ninety-two percent of the patients had refractive errors and 85% of them had astigmatism. Establishing a pattern and the associated clinical characteristics of childhood glaucoma at tertiary care children's hospitals will help in developing collaborative research efforts and effective treatment/management strategies for children with these rare groups of disorders.

The effect of trabeculectomy combined with prophylactic sclerotomy as a treatment of late stage juvenile open angle glaucoma and primary congenital glaucoma patients: a primary observational study

Objective: To evaluate the outcomes of trabeculectomy combined with a new prophylactic sclerotomy in late stage juvenile open angle glaucoma (JOAG) and primary congenital glaucoma (PCG) patients at high risks of intraoperative and postoperative suprachoroidal hemorrhage (SCH). Method: A retrospective case series study. Thirty-three eyes of 28 JOAG patients and 15 eyes of 12 PCG patients with high risk factors for severe choroidal effusion or SCH were enrolled from November 2006 to April 2012 at Eye and ENT Hospital of Fudan University. The standard trabeculectomy accompanied by prophylactic sclerotomy was performed (video attached). Ophthalmic examinations were performed before and after the surgery. Surgical outcome was assessed in terms of intraocular pressure (IOP), best-corrected visual acuity, optic nerve head cup disc ratio, visual field, and complications. All patients were followed up for at least 1 year. Complete success was defined as an IOP ≥6 mmHg (1 mmHg=0.133 kPa) but ≤18 mmHg without medication. Qualified success was defined as an IOP ≥6 mmHg but ≤18 mmHg with local application of medications. Kaplan-Meier survival curves were drawn for the success rate calculation. Results: The mean age of all 40 patients was (13.2±9.4) years old. And among them, 22 patients were male and 18 patients were female. The mean follow-up time was (31.8±15.9) months. At the postoperative 3(rd) year, the complete success rate was 75.8%, and the qualified success rate was 90.0%. In our case series, one eye had expulsive SCH intraoperatively and two eyes had delayed SCH postoperatively. All of them were successfully saved without further surgery and with no significant damage to visual function. Conclusion: Trabeculectomy combined with prophylactic sclerotomy is a promising technique developed to control IOP in late stage JOAG and PCG patients, which provides a potential intervention to reduce severe consequences of massive choroidal effusion or SCH. (Chin J Ophthalmol, 2019, 55: 347-354).

Peripapillary capillary vessel density progression in advanced glaucoma: a case report

BackgroundWe report a case of advanced juvenile open-angle glaucoma (JOAG) in which peripapillary capillary vessel density (PcVD) in the inferior retina showed significant progression while the spatially corresponding retinal nerve fiber layer thickness (RNFLT) and visual field cluster defect values had reached their minimal detectable values, and showed no change during the follow-up (floor effect).Case presentationA 45-year old white female patient with very advanced under treatment JOAG in the left eye was prospectively investigated with the AngioVue OCT (Optovue Inc., Fremont, USA) for RNFLT and PcVD, and Octopus Normal G2 visual field testing, at 6-month intervals for 2.5 years (6 visits). Images quality was high (8/10 in 5 visits and 7/10 in one visit), and the optical media were clear. For the superior and inferior retina the baseline RNFLT and PcVD values were 48 and 43 μm, and 28.9 and 36.5%, respectively. Using the instrument’s linear regression analysis significant progression (P < 0.05) was seen only for the hemifield with greater baseline RNFLT (superior RNFLT: − 0.5 μm/year) and the hemifield with greater baseline PcVD (inferior PcVD: − 2.4%/year). All inferior visual field cluster defect values progressed significantly (2.0 to 5.1 dB/year) while in the superior clusters no progression was measurable due to software indicated floor effect.ConclusionOur case shows that PcVD progression can be measured in advanced glaucoma, that PcVD can show floor effect, and that it may indicate glaucomatous progression when the spatially corresponding RNFLT and visual field cluster defect do not show progression due to floor effect.

Bilateral juvenile open-angle glaucoma with keratoconus: A rare association and literature review

Juvenile open-angle glaucoma (JOAG) is a subset of primary open-angle glaucoma, which affects individuals aged 5 to 35 years. Keratoconus is a bilateral progressive ectatic disorder of the cornea that results in a reduction of vision due to irregular astigmatism. The exact cause and the underlying pathological mechanism are unknown, but both environmental and genetic factors are thought to contribute to the development of the disorder. The association between keratoconus and normal-tension glaucoma has been widely published in literature, whereas the association between keratoconus and JOAG has been reported rarely. This is the third case report pointing toward the possible association of juvenile glaucoma with keratoconus, which emphasizes the importance of thorough glaucoma evaluation among keratoconus patients.

Profile of childhood glaucoma at a tertiary center in South India.

Purpose:To describe the prevalence of various types of childhood glaucomas, their clinical features and treatment methods.Methods:We prospectively included consecutive children with glaucoma presenting to glaucoma clinic for the first time between March 2013 and May 2014. We classified childhood glaucomas as per the classification proposed by Congenital Glaucoma Research Network.Results:Of the 275 children (449 eyes) with glaucoma during this period, primary glaucomas constituted 56% (n = 252 eyes of 145 children), including 169 eyes (37.64%) of 97 children with primary congenital glaucoma (PCG), 16 eyes (3.56%) of 10 children with infantile glaucoma, and 67 eyes (14.9%) of 38 children with juvenile open angle glaucoma. Among these, 85% (214 eyes of 107 children) had bilateral involvement. Secondary glaucomas constituted 44%; they were glaucoma associated with ocular anomalies 18% (n = 80 eyes), glaucoma associated with acquired conditions (steroid induced and traumatic glaucoma) 14% (n = 61 eyes), glaucoma following congenital cataract surgery 7.6% (n = 34 eyes), and glaucoma associated with systemic or syndromic conditions 5% (n = 22 eyes). In primary glaucomas, boys and girls were equally affected (1:1), and more boys (3.8:1) had acquired glaucomas. Close to 80% PCG eyes were managed surgically with combined trabeculotomy and trabeculectomy (CTT). Majority of secondary glaucomas were managed medically.Conclusion:In our cohort, PCG was the most common childhood glaucoma and CTT was the most common surgery performed in these eyes. Steroid-induced and traumatic glaucomas were the most common acquired glaucomas; appropriate measures should be taken to avert these preventable glaucomas in children.

Juvenile primary open-angle glaucoma and keratoconus

Juvenile primary open-angle glaucoma and keratoconus

Juvenile open-angle Glaucoma associated with Leber\u2019s hereditary optic neuropathy: a case report and literature review

BackgroundLeber’s hereditary optic neuropathy (LHON) is a maternally inherited recessive disease rarely complicated with glaucoma. We conducted a clinical and genetic retrospective case series to describe three cases of juvenile open-angle glaucoma (JOAG) and an ND4 m11778G > A mitochondrial DNA (mtDNA) mutation, which is pathognomonic for LHON.Case presentationPatient 1 was a 16-year-old boy diagnosed with bilateral JOAG and high myopia. His intraocular pressure (IOP) was poorly controlled with the use of full topical anti-glaucoma medications. His best-corrected visual acuity (BCVA) decreased gradually over 5 years. Fundoscopic examination revealed bilateral enlarged disc cupping of the optic nerves with sectorial excavation and reduction of the neural rim in the left eye. His visual field (VF) was characterized by bilateral progressive central scotoma. Pattern visual evoked potentials (VEPs) and pattern electroretinograms (ERGs) showed extinguished responses in both eyes. Because of the non-specific visual field findings and the optic neuropathy disclosed by the pattern VEPs and pattern ERGs, we arranged a genetic test for the patient, which revealed an m11778G > A mtDNA mutation. Patient 2, the younger brother of Patient 1, was a 15-year-old boy who had been diagnosed with bilateral JOAG in 2010. The BCVA of both eyes remained at 1.0 during the follow-up period. Fundoscopic examination revealed bilateral mildly paled optic disc with enlarged cupping and reduction of the neural rim. The pattern ERG revealed a decreased N95 amplitude bilaterally. The genetic test revealed an m11778G > A mtDNA mutation. Patient 3 was a 35-year-old man with bilateral JOAG. His BCVA decreased gradually over 10 years. Fundoscopic examination revealed paled optic disc with enlarged disc cupping and reduction of the neural rim in both eyes. The pattern ERG revealed a decreased N95 amplitude bilaterally. The genetic test revealed an m11778G > A mtDNA mutation.ConclusionsThis case series describes three patients with concomitant occurrence of JOAG and LHON. These two diseases may have a cumulative effect on oxidative stress and retinal ganglion cell death with the rapid deterioration of vision, which may occur during adolescence.

New classification system for pediatric glaucoma: implications for clinical care and a research registry.

The Childhood Glaucoma Research Network (CGRN) has created a new classification system for childhood glaucoma that has become the first International Consensus Classification. The purpose of this review is to present this classification system and share its use to date. The diagnoses of the classification system include glaucoma and glaucoma suspect. The primary glaucomas include: primary congenital glaucoma and juvenile open-angle glaucoma. The secondary glaucomas include: glaucoma following cataract surgery, glaucoma associated with nonacquired systemic disease or syndrome, glaucoma associated with nonacquired ocular anomalies, and glaucoma associated with acquired conditions. This system reached consensus agreement at the Ninth World Glaucoma Association Consensus, which has been adopted by the American Board of Ophthalmology, and has been implemented in outcomes research, incidence studies, and review articles. The new Robison D. Harley, MD CGRN International Pediatric Glaucoma Registry uses this classification system as a shared language, allowing international clinicians and researchers to collaborate and make large-scale investigations of this otherwise rare disease possible. The diagnoses in this system are assigned by following a logical and systematically approachable path. The ability to easily adopt and implement the system lends itself to international research.

Histochemical Analysis of Glaucoma Caused by a Myocilin Mutation in a Human Donor Eye

Mutations in myocilin (MYOC) may cause either juvenile open angle glaucoma (JOAG) or adult-onset primary open angle glaucoma (POAG). MYOC encodes a glycoprotein that is normally secreted from trabecular meshwork cells that regulate intraocular pressure. Prior in vitro, transgenic rodent, and organ culture experiments have suggested that abnormal accumulation of MYOC protein within trabecular meshwork cells is a key step in glaucoma pathophysiology. We investigated the pathogenesis of MYOC glaucoma by examining a donor eye from a patient with JOAG caused by a Tyr437His MYOC mutation. Case-control, immunohistochemical study of a donor eye from a patient with JOAG caused by a Tyr437His MYOC mutation and age-matched control donor eyes. An eye from a 59-year-old male with JOAG caused by a Tyr437His MYOC mutation and eyes from five donors (ages 51-66) with no known ocular disease were examined. Frozen fixed sections of the iridocorneal angle were prepared from the donor eyes of the MYOC glaucoma patient and control eyes. We used antibodies directed against MYOC, collagen IV, and BiP/GRP78 as well as wheat germ agglutinin and concanavalin A lectins to localize MYOC protein in the trabecular meshwork. Qualitative comparison of MYOC protein labeling and localization in the trabecular meshwork of donor eyes from a glaucoma patient with a MYOC mutation and from control subjects. Using immunohistochemistry, we detected more abundant MYOC protein within the trabecular meshwork of the MYOC glaucoma patient's eye than in control eyes. We further localized MYOC protein within the trabecular meshwork cells of the MYOC glaucoma patient's eye by co-labeling with the endoplasmic reticulum (ER) marker GRP78 (BiP). Little to no MYOC was identified within the trabecular meshwork cells of control eyes. Minimal extracellular MYOC was detected in both MYOC glaucoma eyes and control eyes. This is the first histopathological analysis of an eye from a glaucoma patient with a MYOC mutation. Furthermore, this analysis supports our model of MYOC-associated glaucoma, in which MYOC mutations cause abnormal intracellular retention of MYOC within the ER of trabecular meshwork cells as a key step towards development of glaucoma.

Analysis of CYP1B1 sequence alterations in patients with primary open-angle glaucoma of Saudi origin.

Cytochrome P450 Family 1 Subfamily B Member 1 (CYP1B1; OMIM# 601771) gene encodes one of the cytochrome P450 family of enzymes. CYP1B1 mutations have been associated primarily with primary congenital glaucoma (PCG). Similar studies were reported in juvenile open-angle glaucoma, Rieger’s and Peters anomalies. Reports of likely pathogenic sequence alterations in families affected with adult-onset primary open-angle glaucoma (POAG) triggered this investigation. We screened unrelated POAG cases and healthy controls for mutations in CYP1B1 using automated Sanger sequencing to identify five known polymorphisms and one CYP1B1 mutation (p.G61E) in a heterozygous status. The p.G61E mutation is known to cause PCG in a homozygous or compound heterozygous form, and thus, its presence here in a heterozygous form indicates carrier status. These findings suggest that CYP1B1 may have no major role in the pathogenesis of POAG, at least, in the Saudi population. However, further investigations are needed to validate these findings in a larger cohort.

The screening of pathogenic locus in a primary open angle glaucoma pedigree

Objective To screen the pathogenic locus and gene in a primary open angle glaucoma(POAG), and to provide a basis for molecular genetic study of POAG. Methods A POAG pedigree with 35 members was diagnosed in Sichuan peoples' Hospital from January to August 2005.The disease history and clinical data were collected.Genome-wide scan was performed for the families.Specific software was used to calculate the LOD value, which based on the allele (haploid) typing result with two-point method to definite the positive loci by the largest LOD value. Results The POAG family had 35 members of 4 generations.18 patients were diagnosed as juvenile open angle glaucoma from visual disc shape abnormality and loss of typical visual field.All of the patients in this family suffered various degrees of binocular vision loss and vision loss in childhood, with poorly visual function.The LOD values of 3 short tandom repeat (STR) markers on chromosome 2 were greater than 3.0, they were D2S2369 (LOD value 4.003 3), D2S2332 (LOD value 3.840 2) and D2S337 (LOD value 4.752 0). There was a genetic linkage near the three genetic markers in the family.The primary glaucoma positive locus was a in chromosome p15 to chromosome p16.2, and the genetic distance was about 9 Mb, locating in between the markers D2S2369 and D2S2397. Conclusions GLCIH is a pathogenic locus for this POAG pedigree, which supplies an evidence for elucidating the pathogenesis of POAG. Key words: Primary open angle glaucoma; Locus; Genome-wide scan

The Association of Socioeconomic Status with Severity of Glaucoma and the Impacts of Both Factors on the Costs of Glaucoma Medications: A Cross-Sectional Study in West Bengal, India.

To evaluate the association of socioeconomic status (SES) with severity of glaucoma and assess the impacts of both SES and disease-severity factors on the costs of glaucoma medications among different glaucoma subtypes in West Bengal, India. This cross-sectional study (2014-16) followed the treatment of 304 primary glaucoma patients for at least 18 months. The visual field based glaucoma staging was followed for stages 0-3; patients with field of vision <10° were categorized as stage 4 (end stage). We checked only the mean cost of glaucoma medications per patient and not "direct costs." The individuals' monthly incomes were classified into: low, moderate, and higher SES. Urban residence (odds ratio [OR] 0.6, P < 0.009), higher SES (OR 0.3, P < 0.001), and higher awareness (nearly 50%, P < 0.007) significantly lowered the odds of having end-stage glaucoma. Sixty-nine percent primary angle-closure glaucoma (PACG) and 79% juvenile open-angle glaucoma (JOAG) belonged to low SES, forming the bulk of end-stage glaucoma. Overall medical cost from stage 0 to advanced stage in all subtypes rises except in primary open-angle glaucoma (POAG). Only 28% eyes from low SES were treated with branded drugs in early disease and that too declined to 16% in stage 4, while 57% higher SES used branded medications in early disease stage. Expenditure as a percent of income was the highest in JOAG (16%) followed by PACG (15%) and POAG (14%) among low SES. Results indicate SES influences on disease outcome, the clinical management, and the glaucoma medication expenses in West Bengal. Medical costs of glaucoma increase with worsening disease severity; greater use of generic drugs does not always ensure direct cost savings.

Childhood glaucoma profile in Dakahelia, Egypt: a retrospective study.

To analyze childhood glaucoma regarding its demographics, presentations, different causes and surgical modalities used among patients in Dakahelia and to apply the Childhood Glaucoma Research Network (CGRN) classification retrospectively to evaluate its convenience. A retrospective study in which the medical files of all glaucoma patients <16 years old presented to Mansoura Ophthalmic Center, Mansoura University from 2014 to 2017, were retrieved and analyzed. Collected data included: age, gender, laterality, visual acuity (VA), refraction, intraocular pressure (IOP), corneal diameter, cup-disc ratio, types and number of surgeries and antiglaucomatous drugs (AGD) at the first and last visit. Prevalence of different subtypes was calculated and means of clinical features were compared. A total of 305 eyes of 207 patients were included classified into 6 groups: primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), glaucoma associated with systemic disease, glaucoma associated with ocular anomalies, acquired glaucoma and glaucoma following cataract surgery. PCG was the predominant type (55.1%) followed by acquired glaucoma (29.5%). Males represented 63.8% of the whole studied patients. Glaucoma associated with ocular anomaly group showed the youngest age at diagnosis (21.9±30.0mo). The shortest corneal diameter was recorded in post cataract group (10.4±0.5 mm). Highest cup-disc ratio was found in the PCG group (P<0.0005). Glaucoma associated with systemic disease presented with the highest baseline IOP (34.5±5.0 mm Hg). All the cases with PCG were treated surgically with 21.8% required more than one surgery. The majority of the patients (74.2%) in the acquired group were treated medically. Combined trabeculotomy-trabeculectomy was the most frequent operation done, accounting for 34.5% of all primary surgeries. Ahmed valve implantation comprised 87% of the secondary surgeries. Acquired glaucoma group had the highest percent of eyes with good final Snellen's VA (69.4%), while glaucoma associated with ocular anomaly group had poorest final VA. PCG is the most prevalent type of childhood glaucoma, followed by acquired glaucoma especially traumatic hyphema. Combined trabeculotomy-trabeculectomy and Ahmed valve implantation are the most common surgical interventions. CGRN classification is found to provide a consensus skeleton and is recommended to be integrated in our routine ongoing clinical practice.

Visual Disability Among Juvenile Open-angle Glaucoma Patients.

Juvenile onset primary open-angle glaucoma (JOAG) unlike adult onset primary open-angle glaucoma presents with high intraocular pressure and diffuse visual field loss, which if left untreated leads to severe visual disability. The study aimed to evaluate the extent of visual disability among JOAG patients presenting to a tertiary eye care facility. Visual acuity and perimetry records of unrelated JOAG patients presenting to our Glaucoma facility were analyzed. Low vision and blindness was categorized by the WHO criteria and percentage impairment was calculated as per the guidelines provided by the American Medical Association (AMA). Fifty-two (15%) of the 348 JOAG patients were bilaterally blind at presentation and 32 (9%) had low vision according to WHO criteria. Ninety JOAG patients (26%) had a visual impairment of 75% or more. Visual disability at presentation among JOAG patients is high. This entails a huge economic burden, given their young age and associated social responsibilities.