Characteristics and long-term outcomes of childhood glaucoma: a retrospective-cohort study

Abstract

Purpose: To evaluate the clinical characteristics and treatment outcomes of patients with childhood glaucoma. Methods: We retrospectively reviewed the data of patients with childhood glaucoma who visited the glaucoma clinics at the Queen Sirikit National Institute of Child Health and the King Chulalongkorn Memorial Hospital between January 2008 and January 2018. The diagnosis was based on the Childhood Glaucoma Research Network classification. We recorded their clinical characteristics and requirement of any glaucoma interventions. Results: A total of 691 eyes from 423 patients were included in this study. The patients predominantly comprised boys. The average follow-up duration was 71.3±63.8 months. The mean age at presentation was 3.9±4.4 years. Most patients presented with a high initial intraocular pressure (IOP) of 28.5±11.2 mmHg. Glaucoma associated with non-acquired ocular anomalies (22.9%) was the most common subtype, followed by primary congenital glaucoma (20.8%). We recorded a family history of glaucoma in 6.4% of patients. Most patients had bilateral glaucoma (63.4%) and required at least one intervention (51.5%). The average IOP at the latest follow-up visit was 19.1±10.8 mmHg. All glaucoma types had significantly lower IOP, compared to that at their baselines (all p<0.001). Moreover, most patients had an unfavourable visual acuity (49.5%) at their latest visit. Conclusions: Secondary glaucoma associated with non-acquired ocular anomalies is the most common subtype of glaucoma. All subtypes, including primary glaucoma, were sporadic. The majority of patients had unfavourable visual outcomes. These real-world findings are fundamental to acquire a better understanding of childhood glaucoma.

Clinical Analysis of Pediatric Glaucoma in Central China

“…Conversely, many studies have reported a higher prevalence of secondary glaucoma than PCG. The prevalence of PCG in Hong Kong and Thailand was similar to the 17% reported in the USA and was much lower than in our studies (12,16). The number of boys was more than twice that of girls in this study, which is consistent with reports from northern China, the United States, and Europe (20,21).…”

“…The number of male pediatric patients was higher than that of female patients (63.60% vs. 36.40%; 1.75:1), which is similar to previously published results (12)(13)(14)(15)(16). Moreover, 8.79% of patients in this study had a family history of glaucoma, which was slightly higher than in studies conducted in eastern China and parts of Asia, including Thailand (12,13). Pediatric glaucoma is commonly treated surgically, and medical treatment is assisted by therapy (17).…”

“…The average age of the patients in the study by Baig et al was similar to that in another study conducted in Hong Kong, and patients with JOAG were older (2). Surukrattanaskul et al reported an earlier presentation age in their study (12). This could be related to the different medical referral systems.…”

Ophthalmological Manifestations of Axenfeld-Rieger Syndrome: Current Perspectives

“…Further, increased axial length associated with buphthalmos can lead to significant myopia. 100,101 However, in the previously referenced study, there was no significant difference in average best corrected visual acuity between eyes with ARS that did or did not have glaucoma. 10 Although more rare, involvement of other ocular structures including cataracts, Peters Anomaly, sclerocornea, optic nerve and retinal colobomas worsens visual prognosis.…”

“…10,99 Since ARS is a congenital disease and glaucoma is typically diagnosed during childhood, it is also critical to address refractive error, amblyopia, and strabismus. 101,102 Both high myopia and astigmatism can cause bilateral amblyopia if the refractive error is left uncorrected. Furthermore, asymmetry of refraction (anisometropia) or ocular findings affecting the cornea, lens, retinal or optic nerve can lead to unilateral amblyopia.…”