Management Of Childhood Glaucoma Research Articles

Ahmed and Baerveldt Glaucoma Drainage Devices in Childhood Glaucoma: A Meta-Analysis.

The effectiveness of Ahmed glaucoma valve (AGV) and Baerveldt glaucoma implant (BGI) was comparable in the management of childhood glaucoma over the long term despite initial better success rate with BGI. There were higher tube block and retraction rates in the BGI group and higher tube exposure rates in the AGV group. To evaluate the outcomes and safety of AGV and BGI in childhood glaucoma. We performed a systematic literature review of publications from 1990 to 2022 in PubMed, EMBASE, ClinicalTrials.gov, Ovid MEDLINE, Cochrane CENTRAL, and google scholar for studies evaluating AGV and BGI in childhood glaucoma. Primary outcome measures were intraocular pressure (IOP) reduction and glaucoma medication reduction. The secondary outcome measures were the success rates and incidence of postoperative complications. We conducted a meta-analysis using a random effects model. Thirty-two studies met the inclusion criteria. A total of 1480 eyes were included. The mean IOP reduction was 15.08 mm Hg ( P < 0.00001) for AGV and 14.62 ( P < 0.00001) for the BGI group. The mean difference between pre and postoperative glaucoma medications was 1 ( P < 0.00001) fewer medications in the AGV group and 0.95 ( P < 0.0001) fewer medications in the BGI group. There was a lower success rate in the AGV versus BGI groups at 2 years [63% vs 83%, respectively ( P < 0.0001) and 3 years (43% vs 79%, respectively ( P < 0.0001)]; however, the success was higher for AGV at 5 years (63% vs 56% in the BGI group, P < 0.001). The incidence of postoperative complications was comparable in the AGV and BGI groups, with rates of 28% and 27%, respectively. The IOP and glaucoma medication reduction, success rates, and incidence of postoperative complications were comparable in Ahmed and Baerveldt groups. Most literature comes from retrospective low-quality studies on refractory childhood glaucoma. Further larger cohort studies are needed.

Outcomes of inferonasal glaucoma drainage device surgery in the management of childhood glaucoma

To evaluate indications and postoperative outcomes of inferonasal Ahmed and Baerveldt glaucoma drainage devices (GDDs) in pediatric glaucoma. This retrospective study included patients ≤18 years of age at inferonasal GDD placement, from June 2013 to September 2021. Demographic information, indications, and outcomes were recorded. Successful eyes had intraocular pressure (IOP) ≥5 and ≤21 mm Hg or (in severe cases, where entry IOP was ≤21 mm Hg) 20% below preoperative values without additional IOP-lowering surgery or vision-threatening complications. A total of 68 eyes of 52 patients were included. Mean age was 9.8 ± 5.8 years. Most common diagnoses included primary congenital glaucoma (n = 28 eyes [41%]) and glaucoma following cataract surgery (n = 12 eyes [18%]). Success rates by Kaplan-Meier survival analysis (95% CI) at 1, 2, 3, and 5 years were 62.2% (49.4-72.7), 49.0% (36.3-60.6), 36.8% (24.0-49.8), and 31.9% (18.5-44.5), respectively. Surgical failure was associated with Ahmed (vs Baerveldt) GDD (HR = 3.2; P = 0.002) and inferonasal site as initial (vs subsequent) GDD received (HR = 2.2; P = 0.048). Twenty-five eyes (36.7%) had at least one complication. Although vision-threatening complications were uncommon (n = 2 eyes [3%]), less severe complications were relatively common and included new/worsened strabismus (n = 9 patients [17%]), corneal edema (n = 6 eyes [9%]), lens opacities (n = 4 [6%]), tube or patch graft exposure (n = 3 [4%]), tube blockage (n = 2 eyes [3%]), and other (n = 8 eyes [12%]). In this study cohort, inferonasal GDDs for childhood glaucoma had modest success, with frequent though rarely vision-threatening complications.

Management of Childhood Glaucoma Following Cataract Surgery.

Glaucoma remains a frequent serious complication following cataract surgery in children. The optimal approach to management for ‘glaucoma following cataract surgery’ (GFCS), one of the paediatric glaucoma subtypes, is an ongoing debate. This review evaluates the various management options available and aims to propose a clinical management strategy for GFCS cases. A literature search was conducted in four large databases (Cochrane, PubMed, Embase, and Web of Science), from 1995 up to December 2021. Thirty-nine studies—presenting (1) eyes with GFCS; a disease entity as defined by the Childhood Glaucoma Research Network Classification, (2) data on treatment outcomes, and (3) follow-up data of at least 6 months—were included. Included papers report on GFCS treated with angle surgery, trabeculectomy, glaucoma drainage device implantation (GDD), and cyclodestructive procedures. Medical therapy is the first-line treatment in GFCS, possibly to bridge time to surgery. Multiple surgical procedures are often required to adequately control GFCS. Angle surgery (360 degree) may be considered before proceeding to GDD implantation, since this technique offers good results and is less invasive. Literature suggests that GDD implantation gives the best chance for long-term IOP control in childhood GFCS and some studies put this technique forward as a good choice for primary surgery. Cyclodestruction seems to be effective in some cases with uncontrolled IOP. Trabeculectomy should be avoided, especially in children under the age of one year and children that are left aphakic. The authors provide a flowchart to guide the management of individual GFCS cases.

International Study of Childhood Glaucoma

To ascertain the types of childhood glaucoma managed at major international centers, current clinical practice, and intraocular pressure (IOP) control and visual acuity (VA) outcomes. Prospective, multicenter, consecutive case series. All children with newly diagnosed glaucoma in at least 1 eye who fulfilled the Childhood Glaucoma Research Network (CGRN) definition of childhood glaucoma were recruited over a 1-year period with the aim of 18 months follow up. Demographic, clinical, management data (including complications), and outcomes (IOP and VA) were entered in a secure online database. All cases included in the outcome analysis had a minimum of 6 months follow-up. The management of childhood glaucoma, IOP control, and VA outcomes. A total of 441 children (691 eyes) with newly diagnosed glaucoma were enrolled from 17 international centers. Approximately 60% of patients came from 2 centers in India; however, 47.5% of Indian patients had no or less than 6 months of follow-up outcome data from diagnosis. Primary congenital glaucoma (PCG) was the most common diagnosis (45.4%, n= 314 eyes). There was a statistically significant association between diagnosis and ethnicity/race (P < 0.001), with PCG more frequent in nonwhite patients, glaucoma associated with acquired conditions more frequent in South Asian patients, and glaucoma after cataract surgery more frequent in white patients. The initial surgical procedure of choice for eyes with PCG significantly differed by country. Angle surgery alone was first line in centers in the United States, United Kingdom, Germany, Saudi Arabia, Singapore, and Israel (Group 1), whereas combined trabeculotomy-trabeculectomy was the first-line procedure for PCG in centers in India and Ghana (Group 2). There was no significant difference in IOP control nor VA between the 2 groups. The most common diagnoses in this international study of children with newly diagnosed glaucoma in order of frequency were PCG, glaucoma after congenital idiopathic cataract surgery, and glaucoma associated with trauma. Indian children had a disproportionately high loss to follow-up rate. Despite international differences in the surgical approach to PCG, there was no statistically significant difference in IOP or VA outcomes. We hope the results of this study will inform key areas of future international, collaborative clinical research in childhood glaucoma.

Childhood glaucoma in Down syndrome: a case report and literature review

Children with down syndrome have a higher prevalence of glaucoma compared to the age matched normal population. Although the management of childhood glaucoma in a down syndrome child is almost similar to primary congenital glaucoma, the outcomes and prognosis of these children vary due to the associated comorbidities. This case illustrates a classical presentation of a 5-month infant with down syndrome with clinical triad of photophobia, blepharospasm, and epiphora. Prompt recognition of the condition and timely surgical management was vision saving in this child. Extended care for visual rehabilitation was given to this child to maintain the visual outcome.

Management of childhood glaucoma in Sturge Weber Syndrome: A challenge.

Sturge-Weber syndrome (SWS) is a rare congenital neuro- oculo- cutaneous disorder. Glaucoma is one of the ocular abnormalities associated with it. Management of glaucoma in SWS is challenging. To report surgical and visual outcome of trabeculectomy in bilateral glaucoma in Sturge-Weber syndrome and the challenges encountered in its management. A six-year-old girl presented with gradually progressive increase in size of both the eyes associated with watering, photophobia and diminution of vision since birth. On examination she was diagnosed to have bilateral SWS with glaucoma, refractive to antiglaucoma medications. She underwent trabeculectomy with intraoperative use of 5- FU. The post operative period was complicated with choroidal effusion in both the eyes with shallow anterior chamber. In the second post operative day, the right eye anterior chamber re- formation was done with ringer lactate solution. There was spontaneous resolution of choroidal effusion with normalization of intraocular pressure with no adverse effect on visual acuity within one week. Treatment of glaucoma associated with Sturge-Weber syndrome is challenging. When planning surgical intervention an increased risk of choroidal effusion associated with it, should be kept in mind.

Trabeculectomy with mitomycin C in the treatment of pediatric glaucoma

目的 观察小梁切除术联合丝裂霉素C(MMC)治疗儿童青光眼的疗效和安全性.方法小梁切除术联合MMC治疗儿童青光眼32例(32眼)年龄3～14岁.术后随访时间6～40月(平均18.07±5.81月),对眼压、视力和并发症进行了分析,以Kaplan-Meier寿命表判断成功率.结果相对成功率标准为:眼压6～21 mmHg,不用或用抗青光眼药物,不需要再进行抗青光眼手术,并且未发生严重的并发症.6月累积成功率为85.47%(n=32),12月为76.32%(n=25),24月为64.29%(n=12).并发症包括浅前房6眼、薄壁滤过泡5眼、滤过泡渗漏3眼、囊样滤过泡2眼、低眼压2眼、滤过泡炎1眼、白内障1眼和视网膜脱离1眼.结论小梁切除术联合MMC可能是治疗儿童青光眼一种有效的方法.然而,MMC术后薄壁滤过泡和滤过泡相关的感染以及其他问题尚需长期随访。

Filtration procedures supplemented with mitomycin C in the management of childhood glaucoma

AIMS To evaluate the outcome of filtering procedures supplemented with mitomycin C in children with glaucoma. METHODS All patients aged 17 or younger with glaucoma who underwent filtering surgery supplemented...