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

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.

Effect Of Trabeculectomy On Ocular Biometry And Refractive Errors In Pediatric Glaucoma

Background: Pediatric glaucoma triggers refractive errors by modifying the biometry of the eye. This study was conducted with the objective of estimating the short-term biometric and refractive changes prior to and post trabeculectomy in pediatric glaucoma. Material and Methods: A 12-month, descriptive, cross-sectional study was carried out from January to December 2019, using patients operated on for pediatric glaucoma. Pre- and post-operative biometric and refraction measurements were noted. Visual acuity, axial length, corneal diameter and refraction were obtained. All ethical requirements (anonymity, free, informed, and continuous consent) were satisfied. Data analysis was done using SPSS 20.0. Results: In the present study, 47 eyes of 27 patients were surgically operated upon, from January 2019 to December 2019 at CHU-IOTA. The predominant sex was male (17 patients) at 63%, giving a sex ratio (M / F) of 1.7. The mean age was 5.04 ± 4.24. Preoperatively, the mean corneal diameter, and D90 were respectively 13.83 ± 1.51 and 12.55 ± 0.99. Preoperatively, the mean axial length, and D90, were 23.87 ± 1.29 and 22.28 ± 1.07, respectively. Preoperatively and at three month, the mean myopia (n = 36), were respectively -3.13 ± 1.83 and -1.59 ± 0.97. The mean preoperative astigmatism (n = 47) and D90 were respectively, -1.59 ± 0.77 and -1.23 ± 0.57. A statistically significant relationship (p <0.05) was found to exist between the preoperative and postoperative data of the axial length, corneal diameter, and refractive errors. Conclusions: Trabeculectomy significantly exerts a short-term positive impact on the biometrics and refraction by modifying the initial measurements and diopters.