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.

Micropulsed diode laser cyclophotocoagulation in recurrent pediatric glaucoma

2019 ◽  
Vol 30 (5) ◽  
pp. 1149-1155 ◽  
Author(s):  
Eman M Elhefney ◽  
Tharwat H Mokbel ◽  
Sherein M Hagras ◽  
Ahmed A AlNagdy ◽  
Adel A Ellayeh ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Diode Laser ◽  
Congenital Glaucoma ◽  
Secondary Outcome ◽  
Cumulative Probability ◽  
Pediatric Glaucoma ◽  
Significant Difference ◽  
The Mean ◽  
Diode Laser Cyclophotocoagulation

Purpose: To evaluate the intermediate-term efficacy and safety of micropulsed diode laser cyclophotocoagulation in recurrent pediatric glaucoma. Patients and Methods: A prospective interventional study included children <16 years old diagnosed with recurrent glaucoma, attending Mansoura University, during the period from July 2017 to November 2017. Micropulsed diode laser sessions were performed in all the cases. The main outcome was the intraocular pressure reduction with monitoring of complications as secondary outcome. The mean follow-up period was 15.08 ± 1.1 (mean: 12–16) months. Results: A total of 36 eyes of 29 patients were included (62% males) with median age of 24 months. Primary congenital glaucoma represented 47.2% of the initial diagnoses. At the 15th month, the mean intraocular pressure dropped significantly from 37.5 ± 11.3 mmHg at baseline to 20.03 ± 2.7 mmHg (p < 0.001) with 37.15% reduction. The mean number of glaucoma medications decreased significantly from 2.6 ± 0.5 pretreatment to 1.7 ± 0.6 at the 15th month (p < 0.001). A total of 24 eyes (66.7%) required second session of treatment with mean number of 1.7 ± 0.5 sessions per eye. The cumulative probability of qualified success was 69.4%, 58.3%, 52.8%, 47.2%, and 41.7% at 1, 3, 6, 12, and 15 months after treatment. Qualified success was achieved in 61% at 15 months without statistically significant difference between the initial diagnoses (p = 0.61). None of the eyes developed any major ocular complications throughout the follow-up period. Conclusion: Micropulsed diode laser was proved to be a safe approach with relative effectiveness in controlling intraocular pressure in children with recurrent glaucoma.

scholarly journals A 2-year prospective multicenter study of ultrasound cyclo plasty for glaucoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giuseppe Giannaccare ◽  
Marco Pellegrini ◽  
Federico Bernabei ◽  
Lara Urbini ◽  
Fulvio Bergamini ◽  
...  
Keyword(s):  
Ciliary Body ◽  
Glaucoma Surgery ◽  
Secondary Glaucoma ◽  
Eye Drops ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Prospective Multicenter Study ◽  
Definition Of

AbstractUltrasound cyclo plasty (UCP) is a recently developed surgical technique for glaucoma allowing a selective and controlled coagulation of the ciliary body. We herein investigated the long-term efficacy and safety of UCP for the treatment of glaucoma. This prospective study included patients with primary and secondary glaucoma. All surgeries were performed using the EyeOP1 device (Eye Tech Care, Rillieux-la-Pape, France). Sixty-six patients were included, and 60 completed regularly the 2-year follow-up. Preoperative IOP was 28.5 ± 9.6 mmHg and significantly decreased to 17.0 ± 5.4 at 2 years (p < 0.001). The daily number of both hypotensive eye drops and acetazolamide tablets decreased significantly (respectively, from 2.6 ± 1.1 to 1.7 ± 1.2 and from 0.7 ± 0.8 to 0.2 ± 0.5; both p < 0.001). At 2 years, 68.1% of patients met the definition of qualified success (IOP < 21 mmHg regardless of glaucoma medications) and 10.3% of patients met the definition of complete success (IOP < 21 mmHg without glaucoma medications). No major intra- or postoperative complications occurred; however, 15 eyes required additional glaucoma surgery. These results suggest that UCP is an effective and safe procedure to reduce IOP in glaucoma patients through a 2-year follow-up period.

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.

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

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 165
Author(s):  
Supawan Surukrattanaskul ◽  
Pukkapol Suvannachart ◽  
Sunee Chansangpetch ◽  
Anita Manassakorn ◽  
Visanee Tantisevi ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Secondary Glaucoma ◽  
Research Network ◽  
Congenital Glaucoma ◽  
Long Term Outcomes ◽  
History Of ◽  
The Mean ◽  
Primary Glaucoma

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.

scholarly journals Epi-Off versus Epi-On Corneal Collagen Cross-Linking in Keratoconus Patients: A Comparative Study through 2-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
F. Cifariello ◽  
M. Minicucci ◽  
F. Di Renzo ◽  
D. Di Taranto ◽  
G. Coclite ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Confocal Microscopy ◽  
Comparative Study ◽  
Corneal Thickness ◽  
Treatment Modalities ◽  
Cross Linking ◽  
Corneal Confocal Microscopy ◽  
Group 2 ◽  
Group 1

Aim. To evaluate two different techniques of cross-linking: standard epithelium-off (CXL epi-off) versus transepithelial (CXL epi-on) cross-linking in patient with progressive keratoconus.Methods. Forty eyes from 32 patients with progressive keratoconus were prospectively enrolled from June 2014 to June 2015 in this nonblinded, randomized comparative study. Twenty eyes were treated by CXL epi-off and 20 by CLX epi-on, randomly assigned, and followed for 2 years. All patients underwent a complete ophthalmologic testing that included uncorrected and best corrected visual acuity, central and peripheral corneal thickness, corneal astigmatism, simulated maximum, minimum, and average keratometry, corneal confocal microscopy, Schirmer I and break-up time (BUT) tests, and the Ocular Surface Disease Index. Intra- and postoperative complications were recorded. The solution used for CXL epi-off comprised riboflavin 0.1% and dextran 20.0% (Ricrolin), whereas the solution for CXL epi-on (Ricrolin TE) comprised riboflavin 0.1%, dextran 15.0%, trometamol (Tris), and ethylenediaminetetraacetic acid. Ultraviolet-A treatment was performed with a UV-X system at 3 mW/cm2.Results. In both groups, a significant improvement in visual function (Group 1: baseline 0.36 ± 0.16 logMAR, two-year follow-up 0.22 ± 0.17 logMAR,p=0.01; Group 2: baseline 0.32 ± 0.18 logMAR, 2-year follow-up 0.27 ± 0.19 logMAR,p=0.01) was recorded. Keratometry remained unchanged in both groups. The mean corneal thickness showed a significant reduction (mean difference of corneal thickness: −55 micron and −71 micron, resp.). One-month after treatment, OSDI©reached 13.56 ± 2.15 in Group 1 (p=0.03) and 11.26 ± 2.12 in Group 2 (p=0.04). At confocal microscopy, abnormal corneal nerve alterations were found in both groups. Fibrotic reaction (43.75%) and activated keratocyte (62.6%) were more commonly recorded in Group 1 than in Group 2 (25.0% and 18.75%), withp=0.668and 0.356, respectively.Conclusion. Our findings demonstrate that both procedures are able to slow keratoconus progression. Both treatment modalities are equivalent in terms of results and related complications. CXL epi-on technique is preferable to CXL epi-off since it preserves the corneal thickness and improves visual acuity, also reducing the postoperative ocular discomfort during the study period.

scholarly journals Evaluation of the relationship between glaucomatous disc subtypes and occurrence of disc hemorrhage and glaucoma progression in open angle glaucoma

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Akiko Yamagami ◽  
Astuo Tomidokoro ◽  
Shun Matsumoto ◽  
Yoshio Yamazaki ◽  
Keiji Yoshikawa ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Open Angle Glaucoma ◽  
Corneal Thickness ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Mean Deviation ◽  
Open Angle ◽  
Glaucoma Progression

AbstractTo compare the occurrence of disc hemorrhages (DH) and glaucoma progression in open-angle glaucoma (OAG) patients with different glaucomatous disc types. Prospective, hospital-based, observational cohort study. OAG patients examined between 2000 and 2005, whose discs were classified as typical myopic glaucomatous (MG), generalized enlargement of cup (GE), or focal glaucomatous (FG) disc type were included and followed for 5 years. The first occurrence of DH during follow-up was analyzed using Kaplan–Meier analysis and difference in DH occurrence based on glaucomatous disc type using the Cox proportional-hazards model to adjust for effects of confounding factors. For inter-group comparison of glaucoma progression, the change rate of the mean deviation, Collaborative Initial Glaucoma Treatment Study scores, and fundus photographs were used. Thirty-nine patients with MG-, 18 with FG-, and 17 with GE-disc types were included. No significant inter-group difference was seen in the rate of glaucoma progression. The five-year probability of DH occurrence was much lower with MG- than with FG- or GE-disc types (P < 0.0220). The central corneal thickness (P = 0.0024) and mean intraocular pressure and its variations (P = 0.0450, 0.0219) contributed to DH occurrence. The MG-disc type demonstrated a much lower DH occurrence during follow-up than other disc types.

scholarly journals Trabeculectomy in Congenital Glaucoma; Experience in Helpers Eye Hospital Quetta

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Mahtab Mengal ◽  
M Afzal Khan ◽  
Aimal Khan ◽  
Manzoor Ahmed ◽  
Rabia Khawar Chaudhry ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Trauma Surgery ◽  
Case Series ◽  
Posterior Segment ◽  
Congenital Glaucoma ◽  
Primary Congenital Glaucoma ◽  
Effective Operation ◽  
Operative Complications ◽  
Corneal Diameter

Purpose: To evaluate outcomes of trabeculectomy in terms of IOP control and its safety in terms of peroperativeand post-operative complications in Primary Congenital Glaucoma.Study Design: Interventional Case-Series.Place and Duration of Study: Helpers Eye Hospital, Quetta, from June 2017 to December 2018.Material and Methods: Thirty eyes of 17 patients were included in this case series after diagnosis of primarycongenital glaucoma. Patients with secondary congenital glaucoma due to trauma, surgery, inflammation, SturgeWeber Syndrome, Neurofibromatosis, cataract, uveitis, aphakia and pseudophakia were excluded from the study.Informed consent was taken from parents. Examination under anesthesia was done before surgery to recordpreoperative IOP, corneal diameter and anterior and posterior segment abnormalities. Primary trabeculectomywas done. Post-operative IOP and corneal diameter was recorded at 1st, 3rd and 6th month and every 6 monthsthereafter under general anesthesia. IOP at 12th month of surgery was the final outcome which was consideredsignificant if IOP was less than 21 mm Hg with stable corneal diameters.Results: Mean preoperative IOP was 25.8 mm Hg. Twenty-three (76.66%) eyes out of 30 eyes were consideredsuccessful with mean IOP of 15.3 mm Hg at last follow-up while 7 (23.33%) cases of failure were observed withpostoperative mean IOP of 27.71 mm Hg. These patients underwent additional surgeries to control IOP.Hyphema was the only complication observed in this study. Postoperative cataract developed in 5 eyes.Conclusion: Primary trabeculectomy is an effective operation and safe surgery for primary congenital glaucoma

scholarly journals Outcomes of lensectomy and risk factors for failure in spherophakic eyes with secondary glaucoma

2017 ◽  
Vol 102 (6) ◽  
pp. 790-795 ◽  
Author(s):  
Divya P Rao ◽  
Praveen J John ◽  
Mohammed Hasnat Ali ◽  
Ramesh Kekunnaya ◽  
Subhadra Jalali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Intervention ◽  
Success Probability ◽  
Significant Risk ◽  
Glaucoma Surgery ◽  
Median Number ◽  
Secondary Glaucoma ◽  
Younger Age ◽  
Cup To Disc Ratio

PurposeTo report the outcomes of lensectomy in spherophakic eyes with subluxated or dislocated crystalline lenses and secondary glaucoma.MethodsLensectomy was performed in 52 eyes, 36 eyes with lens subluxation and 16 eyes with lens dislocation with secondary glaucoma from 1991 to 2016. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg and/or glaucomatous optic disc damage. Complete success was defined as IOP ≥5 and ≤21 mm Hg without antiglaucoma medications (AGMs) or surgery, and eyes needing oral AGM or surgical intervention for IOP control or those with complication causing loss of light perception were considered failure.ResultsMedian (IQR) age at lensectomy was 12 (6–18) years, and median spherical equivalent was −14.5D (−23.7to −13). Median follow-up was 30.6 (5.4–103.4) months. Median logMAR (logarithm of minimal angle of resolution) visual acuity improved from 0.95 (0.6–1.8) to 0.4 (0.2–1.3) after lensectomy (p=0.01). Median IOP decreased from 22 mm Hg (17–31) to 14 mm Hg (11–19) at final follow-up (p=0.01). Median number of AGM decreased from 2 (2–3) to 1 (0–2) at final follow-up (p<0.0001), and glaucoma surgery was needed in four eyes (7.7% eyes). Complete success probability was 69% at 1 year and 51% at 5 years. Younger age (<6 years), higher presenting IOP (>32 mm Hg) and larger cup to disc ratio at presentation were found to be significant risk factors for failure.ConclusionLensectomy was effective in controlling IOP in close to half of all eyes with spherophakia and secondary glaucoma, 40% eyes needed AGM and only 7.7% eyes needed glaucoma surgery for IOP control. In this cohort, younger age, higher IOP and larger cup to disc ratio at presentation were risk factors for poor glaucoma control after lensectomy.

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