Pediatric glaucoma

Abstract

Purpose of review The purpose of this review is to update the clinician on the recent work in the field of pediatric glaucoma. Recent findings Using the iCare tonometer to measure intraocular pressure in children is highly successful. New data from the Infant Aphakia Treatment Study shows that after 5 years of follow-up the risk of developing glaucoma is similar between patients that receive initial intraocular lens implantation and those who are left aphakic. New data shows effective lowering of intraocular pressure using either approach to trabeculotomy: treating the angle partially with trabeculotomes or circumferentially with a suture or iTrack microcatheter. Recent data on an updated approach to trabeculectomy in children shows success in lowering intraocular pressure with few complications, however visual outcomes continue to be suboptimal. A separate study shows that the addition of tenonectomy may not increase surgical success, but may increase survival time and reduce bleb encapsulation. Glaucoma drainage devices in general, and the Ahmed implant in particular, continue to be found to be moderately successful to control intraocular pressure, and are therefore employed, especially after initial angle surgery has failed. Summary Continued work to evaluate the techniques used in the clinical and surgical management of pediatric glaucoma patients support that both newer and older approaches remain standard of care.

<p>Combined Viscodilation of Schlemm’s Canal and Collector Channels and 360° Ab-Interno Trabeculotomy for Congenital Glaucoma Associated with Sturge–Weber Syndrome</p>

“…The microcatheter was then reinserted sequentially into each 180°o f SC and withdrawn in such a way that the entire circumference of the TM was unroofed via a cheese-wiring technique similar to that of suture trabeculotomy. 1 The sodium hyaluronate was then partially removed from the AC and the corneal incision was closed with vicryl sutures to prevent flattening of the AC due to high postero-anterior push typical of vitreous in the infant eye. A small hyphema-an expected part of the procedure and common to most angle-based surgeriesresolved without treatment.…”

Intraocular Pressure Measurement Accuracy and Repeatability of a Modified Goldmann Prism: Multicenter Randomized Clinical Trial

“…3,4,5 Additionally, it is recognized that the effects of LASIK surgery and the corneal biomechanical differences found in children render accurate IOP measurement by the GAT problematic. 6,7,8,9 Attempts have been made to correct the various error components in GAT measurement to yield a standard IOP reading that is comparable between patients. 10,11 However, the process in practice is error prone and cumbersome, leading to almost no clinical adoption by clinicians, with the exception of CCT.…”

Minimally invasive glaucoma surgery in childhood glaucoma

“…traumatic, uveitic) and glaucoma suspects. Traditional surgical methods for childhood glaucoma such as goniotomy, trabeculotomy, trabeculectomy, glaucoma drainage device (GDD) implantation, cyclodestruction, and deep sclerectomy have been reviewed in recent years [5][6][7][8][9]. A limited but growing body of data suggests a role for minimally invasive glaucoma surgery (MIGS) such as gonioscopy-assisted transluminal trabeculotomy (GATT), Trab360/OMNI surgical systems, Kahook Dual Blade (KDB), Trabectome, and the Xen gel stent in select cases of childhood glaucoma.…”