Citation: El-Fayoumi D, Badr Eldine NM, Esmael AF, Ghalwash D, Soliman HM. Retinal nerve fiber layer and ganglion cell complex thicknesses are reduced in children with type 1 diabetes with no evidence of vascular retinopathy. Invest Ophthalmol Vis Sci. 2016;57:5355-5360. DOI: 10.1167/iovs.16-19988 PURPOSE. To determine whether type 1 diabetes (T1DM) in children with a mean age of 12.21 6 3.04 years affects the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) when compared to age-and sex-matched healthy children.METHODS. Forty-six children with T1DM with no diabetic retinopathy (DR) and 50 normal ageand sex-matched controls underwent full clinical ophthalmic and spectral-domain optical coherence tomography (SD-OCT) examination. Using RTVue Fourier-Domain OCT (version 6.11.0.12) average, superior, and inferior RNFL and GCC thicknesses (in lm) were measured. Mean values of patients and the control group were compared. RESULTS.In children with T1DM with no DR, the mean average RNFL thickness was 110.9 lm 6 10.46, and the mean GCC thickness was 95.59 lm 6 5.13; both were significantly thinner than the control group (115.62 lm and 99.30 lm, respectively). The retinal nerve fiber layer and GCC thickness showed no correlation to either age of onset, duration of the disease, or glycosylated hemoglobin (HbA1c). A positive correlation was found between the daily insulin dose and the average RNFL thickness (r ¼ 0.378, P ¼ 0.01). The average GCC in children with dyslipidemia was thinner than those with normal lipid profile (91.29 6 6.46 lm, 97.11 6 3.59 lm, respectively) with a P value of 0.011. CONCLUSIONS.Thinning of the RNFL and GCC in children with T1DM with no DR compared to healthy controls suggests that neurodegenerative changes occur in the absence of vascular changes. It also shows that neurodegeneration is not related to either disease duration, onset, or control.

PurposeTo study the prognostic factors influencing intraocular pressure (IOP) reduction and success rates of paediatric goniotomy and trabeculotomy.PatientsData from patients aged ≤12 years who underwent goniotomy or trabeculotomy for primary congenital glaucoma from 2013 to 2016 were reviewed. The analysis included 452 eyes of which 120 eyes of patients with a median age (IQR) of 6 months (4.1–11 months) underwent goniotomy, and 332 eyes of patients with a median age of 5.2 months (2.3–9.3 months) underwent trabeculotomy.MethodsMultivariate linear regression analysis was used to predict the correlation of preoperative and operative risk factors to the per cent IOP reduction, while multivariate logistic regression was done to determine independent predictors of failure. Failure was defined as a final IOP >18 mm Hg while on medications or the need for another glaucoma procedure.ResultsIn the goniotomy group, the median IOP reduction was 19.4% and was positively correlated to a high initial IOP (p≤0.001) while in the trabeculotomy group, it was 36.8% and mostly influenced by preoperative IOP (p≤0.001), corneal clarity (p=0.04), gender (p=0.04) and consanguinity (p=0.03). The failure rate in the goniotomy group was 56% and was influenced by the preoperative cup-to-disc ratio, while in the trabeculotomy group it was 30% and strongly correlated to positive consanguinity (p≤0.001), higher preoperative IOP (p=0.003), female gender (p=0.01) and younger age at surgery (p=0.03).ConclusionSeveral factors can predict the outcome of angle surgery and can help in deciding the appropriate surgical intervention in paediatric glaucoma. Trabeculotomy seems to be superior to goniotomy in primary congenital glaucoma.

There is a good correlation between rebound tonometer and Perkins applanation tonometer in children with and without primary congenital glaucoma; however, rebound tonometer overestimates the intraocular pressure, and in intraocular pressure >15 mmHg there is less agreement between the two devices. Hence, in higher intraocular pressure measurement caution should be taken when interpreting rebound tonometer readings, and a confirmatory measurement using Perkins applanation tonometer is advised.

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Purpose To describe the prevalence and clinical characteristics of a large cohort of childhood glaucoma patients that presented to a tertiary Egyptian children’s hospital using the childhood glaucoma research network (CGRN) classification. Methods A retrospective review of the medical records of all patients ≤ 14 years with a diagnosis of childhood glaucoma or glaucoma suspects who presented to Children’s Hospital between January 2014 to December 2019 was conducted. Data collected included age at the time of diagnosis, gender, laterality, prenatal history, parental history, including consanguinity, intraocular pressure, horizontal corneal diameter, and cup-to-disc ratio. Results A total of 1113 eyes of 652 patients with diagnoses of either childhood glaucoma or glaucoma suspects were included in the study. Six hundred and sixteen patients (94%) were born full-term. A history of positive parental consanguinity was identified in 334 patients (51.2%). Almost 60% of patients were males. Primary congenital glaucoma (PCG) was the most prevalent diagnosis (68.2%), followed by glaucoma suspects (10.4%) and glaucoma following cataract surgery (GFCS) (8.4%). Juvenile open-angle glaucoma was the least prevalent category (0.3%). Other categories including glaucoma associated with non-acquired systemic disease, glaucoma associated with non-acquired ocular disease, and glaucoma associated with acquired conditions represented 5.8%, 4.7%, and 1.9%, respectively. Conclusions PCG is the most common form of glaucoma in Egypt. More than half of the pediatric glaucoma patients had a positive history of parents’ consanguinity.