Ultrasound biomicroscopic patterns after glaucoma surgery in congenital glaucoma

Ophthalmology ◽  
2000 ◽  
Vol 107 (6) ◽  
pp. 1200-1205 ◽  
Author(s):  
Thomas S Dietlein ◽  
Bert F Engels ◽  
Philipp C Jacobi ◽  
Günter K Krieglstein
Keyword(s):  
Glaucoma Surgery ◽  
Congenital Glaucoma

Co-existing lacrimal drainage anomalies in eyes with congenital Glaucoma

2022 ◽  
pp. 112067212110734
Author(s):  
Sirisha Senthil ◽  
Mohammad Javed Ali ◽  
Raghava Chary ◽  
Anil K Mandal
Keyword(s):  
Time Delay ◽  
Glaucoma Surgery ◽  
Nasolacrimal Duct ◽  
Congenital Glaucoma ◽  
Treatment Interventions ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Canalicular Obstruction ◽  
Lacrimal Fistula ◽  
Lacrimal Drainage

Aim To evaluate the occurrence of co-existing congenital nasolacrimal duct obstruction (CNLDO) and other lacrimal anomalies in eyes with congenital glaucoma (CG). Methods Retrospective analysis of children aged ≤1-year with co-existing CG and CNLDO seen between 1998 and 2019, treatment interventions and outcomes. Results During the study period, 1993 children had CG and 6203 children had CNLDO, among the children aged 1-year or less. Of these, 51 children (73 eyes) had co-existing CG and CNLDO. The prevalence of CNLDO in CG was 2.5% (51/1993) and the prevalence of CG among CNLDO was 0.8% (51/6203). Median age (Interquartile range, IQR) was 53 days (IQR: 8, 155), when they were diagnosed with CG. Among the children with CNLDO, 68 eyes (93.1%) had simple CNLDO, and 5 eyes (6.9%) had complex CNLDO. Associated lacrimal anomalies were present in 7/73 eyes, including congenital lacrimal fistula in two eyes, upper punctal agenesis and upper mid-canalicular obstruction in two eyes each, and upper single canalicular-wall hypoplasia in one eye. Lacrimal syringing and probing were successful in 69/72 eyes (95.8%), and failed in 3 eyes (4.2%). These 3 eyes had complex CNLDO and underwent Dacryocystorhinostomy (DCR) with Mitomycin-C and intubation. Sixty-two eyes underwent combined trabeculotomy and trabeculectomy, and two eyes underwent trabeculectomy. Median age at glaucoma surgery was 87 days (IQR: 54, 193). Median time delay for glaucoma surgery after probing was 18 days (IQR: 12, 35). Conclusion Among children aged ≤1-year presenting with congenital glaucoma coexisting lacrimal drainage anomalies was noted in 2.5% and simple CNLDO was the commonest. Early intervention is of paramount importance to prevent sight-threatening intraocular infection with CNLDO, and to minimize the delay of glaucoma surgery. The outcomes of lacrimal probing were excellent, however complex CNLDO required DCR.

Long-Term Visual Outcomes in Children with Primary Congenital Glaucoma

2017 ◽  
Vol 27 (6) ◽  
pp. 705-710 ◽  
Author(s):  
Sanaa A. Yassin
Keyword(s):  
Visual Impairment ◽  
Visual Outcome ◽  
Glaucoma Surgery ◽  
Congenital Glaucoma ◽  
Primary Congenital Glaucoma ◽  
Visual Outcomes ◽  
Antiglaucoma Medication ◽  
Poor Visual Outcome ◽  
The Mean

Purpose To determine the long-term visual outcomes and risk factors for visual loss in children with primary congenital glaucoma (PCG) who underwent angle surgery over a 21-year period. Methods This was a retrospective study of patients who underwent trabeculotomy, trabeculectomy, or combined trabeculotomy-trabeculectomy for PCG. Visual acuity (VA), surgeries, and underlying cause of visual impairment were recorded and compared. Main outcome measures were final best-corrected good VA (20/20 to 20/50), moderate VA (<20/50 to 20/200), or poor VA (<20/200); age at surgery, sex, laterality, type of initial glaucoma surgery, and number of surgeries were recorded. Results Fifty-three eyes were eligible to be included in the study. The mean logMAR VA was 0.61 ± 0.57. A good VA was attained in 51%, moderate VA in 30%, and poor VA in 19%. The main cause of visual impairment with VA <20/50 was deprivation amblyopia (64%). There was no association between VA level and status of success (controlled with or without medications) (p = 0.202). The mean spherical equivalent of refraction was -4.47 ± 5.66; myopia was the predominant refractive error (74%) and astigmatism >2 D (40%). A statistically significant high myopic shift was more frequent in the visually impaired group. None of the studied factors was statistically associated with moderate to poor visual outcome (all p>0.05). Conclusions A favorable VA outcome was achieved. Topical antiglaucoma medication has an adjuvant role in maintaining the success rate of surgery without risking the visual outcome. Corneal opacification and anisometropia were the cause of amblyopia.

scholarly journals Twenty-Years of Experience in Childhood Glaucoma Surgery

2021 ◽  
Vol 10 (24) ◽  
pp. 5720
Author(s):  
Felix Mathias Wagner ◽  
Alexander Karl-Georg Schuster ◽  
Franz Grehn ◽  
Lukas Urbanek ◽  
Norbert Pfeiffer ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Medical Center ◽  
Glaucoma Surgery ◽  
Congenital Glaucoma ◽  
Surgical Interventions ◽  
Surgical Success ◽  
Different Types ◽  
Juvenile Glaucoma

To quantify the results of childhood glaucoma treatment over time in a cohort of children with different types of childhood glaucoma. A retrospective cohort study of consecutive cases involving children with primary congenital glaucoma, primary juvenile, and secondary juvenile glaucoma at the Childhood Glaucoma Center, University Medical Center Mainz, Germany from 1995 to 2015 was conducted. The main outcome measure was the long-term development of intraocular pressure. Further parameters such as surgical success, refraction, corneal diameter, axial length, and surgical procedure in children with different types of childhood glaucoma were evaluated. Surgical success was defined as IOP < 21 mmHg in eyes without a need for further intervention for pressure reduction. A total of 93 glaucomatous eyes of 61 childhood glaucoma patients with a mean age of 3.7 ± 5.1 years were included. The overall mean intraocular pressure at first visit was 32.8 ± 10.2 mmHg and decreased to 15.5 ± 7.3 mmHg at the last visit. In the median follow-up time of 78.2 months, 271 surgical interventions were performed (130 of these were cyclophotocoagulations). Many (61.9%) of the eyes that underwent surgery achieved complete surgical success without additional medication. Qualified surgical success (with or without additional medication) was reached by 84.5% of the eyes.

Clinical profile and outcome of early surgery in neonatal-onset glaucoma presenting over a 5-year period

2020 ◽  
pp. bjophthalmol-2020-317230
Author(s):  
Sushmita Kaushik ◽  
Deepika Dhingra ◽  
Atul Arora ◽  
Mini P Singh ◽  
Savleen Kaur ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Disease Onset ◽  
Significant Proportion ◽  
Glaucoma Surgery ◽  
Pressure Control ◽  
Severe Form ◽  
Congenital Glaucoma ◽  
Early Surgery ◽  
Neonatal Onset ◽  
Dismal Prognosis

BackgroundNeonatal-onset glaucoma (NOG) is a severe form of childhood glaucoma and is not always due to primary congenital glaucoma (PCG). Due to advances in neonatal care, the incidence of NOG is rising, but it remains an under-reported entity. The objective of the paper was to study the clinical profiles, surgical and visual outcomes of NOG at least 1 year following early surgery.MethodsProspective interventional cohort study at a tertiary care referral centre. Babies with NOG, who presented between January 2013 and December 2017, had a history suggestive of disease onset within 1 month of birth, and underwent surgery by 3 months of age, were prospectively enrolled. Those who completed a 1-year follow-up after surgery were analysed.Results94 eyes of 53 babies were analysed. 35 (66%) had PCG. Neonatal congenital ectropion uveae, congenital rubella syndrome, Peter’s anomaly and Sturge-Weber syndrome comprised the non-PCG group. The mean age at presentation and surgery was 24.8±21.9, and 36.7±29.9 days. Additional glaucoma surgery was required in 43 of the 94 eyes (45.7%). PCG had significantly better outcomes than other glaucomas at all time points. 28.3% of eyes had good vision (LogMar (0–0.5)), 34.7% had moderate visual impairment (LogMar 0.7–1.0) and 16% were blind (LogMar <1.62) .ConclusionOur study shows that NOG does not always have a dismal prognosis. A small but significant proportion could have other underlying conditions than PCG. Timely surgery and rigorous amblyopia therapy resulted in good outcomes in terms of intraocular pressure control and vision in this cohort.

scholarly journals The relationship between axial length, age and intraocular pressure in children with primary congenital glaucoma

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ibrahim Al-Obaida ◽  
Adi Mohammed Al Owaifeer ◽  
Khabir Ahmad ◽  
Rizwan Malik
Keyword(s):  
Intraocular Pressure ◽  
Axial Length ◽  
Care Facility ◽  
Glaucoma Surgery ◽  
Clinical Parameter ◽  
Congenital Glaucoma ◽  
Primary Congenital Glaucoma ◽  
Number Of Children ◽  
Predicted Values ◽  
The Relationship

Abstract Whilst axial length (AxL) from ultrasound examination is a useful clinical parameter for monitoring progression in younger children with glaucoma, distinguishing AxL changes due to raised intraocular pressure (IOP) from age is often challenging. Existing normograms have included a limited number of children with glaucoma. The aim of this study was to evaluate the relationship between AxL with age and IOP in children with primary congenital glaucoma (PCG) and develop a model for expected AxL increase with age. All children (n = 208; 397 eyes) with PCG who attended our tertiary eye care facility from June 2014 and July 2018 and had AxL and IOP measurements were included. The relationship of AxL with age and IOP was studied by applying a LOWESS fit and then mixed effects models. In the final model, age was the most significant factor influencing the growth of AxL (coefficient age 3.14[95% CI 2.91–3.35, p < 0.001], coefficient age2 − 0.53[95% CI, − 0.59 to − 0.47, p < 0.001]), and this association was influenced by the interaction of IOP with sex (p = 0.098 for girls relative to boys), the number of antiglaucoma medications (AGM [p < 0.001 for ≥ 3 AGM]) and glaucoma surgery (p = 0.015). This model enabled us to derive predicted values for clinical use in children with PCG to predict those with progressive glaucoma.

scholarly journals Progression in pediatric glaucoma: Lessons learnt from 8 years’ follow-up

2021 ◽  
Vol 10 (3) ◽  
pp. 138-145
Author(s):  
Farideh Sharifipour ◽  
Elahe Arasteh ◽  
Maryam Hajizadeh ◽  
Atefe Mahdian-Rad ◽  
Mohammad Sadegh Mirdehghan
Keyword(s):  
Systemic Disease ◽  
Corneal Thickness ◽  
Glaucoma Surgery ◽  
Secondary Glaucoma ◽  
Congenital Glaucoma ◽  
Treatment Modalities ◽  
Glaucoma Progression ◽  
Pediatric Glaucoma ◽  
Corneal Diameter

Background: Surgical procedures are used as 1 of the main treatment modalities for pediatric glaucoma, even though progression may occur. In this study, we aimed to investigate the risk factors affecting the progression of pediatric glaucoma.Methods: In this retrospective cohort study, we reviewed the medical records of patients diagnosed with pediatric glaucoma between April 2009 and March 2017. Pediatric glaucoma patients who underwent regular follow-up for at least 1 year were included. Demographics, intraocular pressure (IOP), central corneal thickness (CCT), axial length (AL), cup-to-disc ratio (C/D ratio), corneal diameter, type of glaucoma, age at time ofdiagnosis, and age at surgery were recorded. Progression was defined as an increase in AL > 2 mm, C/D ratio > 0.2, or corneal diameter > 1 mm during 1 year of follow-up.Results: Eighty-three eyes from 46 patients were included: 37 eyes (45%) with primary congenital glaucoma (PCG), 46 eyes (55%) with secondary glaucoma, and 27 of these 83 eyes (32.5%) showed progression. Progression was comparable between eyes with PCG and secondary glaucoma (PCG, 22%; secondary glaucoma, 41%; P = 0.152). Age at the time of diagnosis and age at the time of the first surgery were significantly lower in the eyes with progression (P = 0.046 and 0.012, respectively). The mean ± standard deviation of surgeries in progressed versus non-progressed eyes was 1.88 ± 1.1 versus 1 ± 0.8 (P = 0.015). The frequency of comorbid systemic disease was significantly higher in patients with glaucoma progression (P = 0.043). The progressed and non-progressed eyes were comparable in terms of other demographic characteristics and ocular parameters (allP > 0.05).Conclusions: Pediatric glaucoma patients who were younger at the time of diagnosis and the first glaucoma surgery and those with comorbid systemic disease are at higher risk of glaucoma progression. These findings are useful for clinicians when counseling parents of children with pediatric glaucoma about disease outcomes. However, future prospective studies with larger sample sizes and longer follow-up periods are needed to confirm our findings.

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