Profile of primary childhood glaucoma at a child eye health tertiary facility in Malawi

Abstract

Background To describe the clinical characteristics and treatment of primary childhood glaucoma at Queen Elizabeth Central Hospital in Blantyre, Malawi. Methods A retrospective case notes review was undertaken of all medical records of patients aged less than 16 years with a diagnosis of primary glaucoma according to the Childhood Glaucoma Research Network Classification (CGRN) who presented from January 2016 to December 2018. The parameters extracted from the case files included age at presentation, sex, type of glaucoma, presenting complaints, laterality of ocular involvement, examination findings and the treatment modality instituted. The Mann-Whitney test was used to investigate factors associated with the intraocular pressure (IOP) in eyes that had a higher presenting IOP value compared to contralateral eyes. Results A total of 45 subjects (80 eyes) were identified, 42 with primary congenital glaucoma (PCG) and 3 with juvenile open angle glaucoma (JOAG). The mean age for the population was 2.6 years (S.D ± 3.7) and most of the patients were male, with a male-female ratio of 2:1. The majority of patients had bilateral disease (n = 35, 77.8%) with the commonest presenting complaint being a whitish appearance of the eye (57.5%). The eyes studied had a mean IOP of 30.1 mmHg (CI 27.4–32.9), a mean horizontal corneal diameter (HCD) of 13.6 mm (CI 13.1–14.2) and a mean cup-disc-ratio `(CDR) of 0.73 (CI 0.66–0.79). In addition, 62 eyes (77.5%) had corneal haze on examination. Most patients (n = 59, 73.8%) underwent a combined trabeculotomy – trabeculectomy surgery within the study period. The median presenting IOP was significantly higher with JOAG compared to PCG (P = 0.02). Conclusion PCG was the most common primary childhood glaucoma at Queen Elizabeth Central Hospital and most patients presented with bilateral eye involvement. Most of the eyes had corneal haze and JOAG was associated with a higher presenting IOP compared to PCG. Further studies to investigate the outcomes of combined trabeculotomy – trabeculectomy surgery in primary childhood glaucoma in Malawi are recommended.

Childhood glaucoma profile in a Southwestern Ethiopia tertiary care center: a retrospective study

“…During the 3-year study period PCG was the most common type of childhood glaucoma (42%), consistent with previous studies [ 11 – 14 ]. The mean age at presentation of PCG patients was 2.7 years old, which is significantly older than the mean age at presentation of 11 months in developed countries [ 15 ], however similar to reports in developing countries [ 16 , 17 ]. Late presentation of PCG patients in the developing world is a well-known challenge [ 18 ].…”

One-year costs of incisional glaucoma surgery and laser therapy

“…The frequency and cost of re-admission were also high in the 0–19 age group. Childhood glaucoma is usually treated bilaterally [ 26 ] and often requires incisional surgery, because the safety of medication in children is not well established. The costs of postoperative outpatient treatment were low in the 0–19 age group.…”

Modification of Profiles of Patients with Glaucoma in Connection with Application of Health Insurance

“…Демографическая характеристика пациентов с глаукомой в клинике АМУ сходна с таковой по литературным данным [3,10,11]. Заметной особенностью контингента пациентов АМУ является высокая доля лиц с первичной открытоугольной глаукомой (73,0% и 71,5%).…”

“…Выбор тактики лечения глаукомы зависит от демографического и клинического профиля пациентов [2,3]. Демографическая и клиническая характеристика пациентов различается в зависимости от типа медицинского учреждения и этапа офтальмологической помощи [10][11][12]. В глазной больнице Южной Индии, где изучен профиль молодых (до 40 лет) госпитализированных, среди пациентов преобладали мужчины (65%) и лица в возрасте 31-39 (34,2%) и 21-30 (31,7%) лет [13].…”

“…В глазной больнице Южной Индии, где изучен профиль молодых (до 40 лет) госпитализированных, среди пациентов преобладали мужчины (65%) и лица в возрасте 31-39 (34,2%) и 21-30 (31,7%) лет [13]. В большинстве клиник прослеживается иной демографический профиль [2,11,14]. Среди пациентов с глаукомой высока доля пожилых людей пенсионного возраста, которые сталкиваются с трудностями оплаты расходов на лечение [15].…”