ABSTRACT
Glaucoma management during pregnancy is a challenge for the patient and doctor. During pregnancy, the intraocular pressure (IOP) decreases. However, some women with preexisting glaucoma have elevated IOP requiring enhanced medical treatment. Glaucoma refractory to medical treatment combined with disease progression may necessitate laser trabeculoplasty or surgical intervention. Surgery during pregnancy has potential risks for both the mother and fetus. The challenges include problems with anesthesia, positioning for surgery, difficulties in the surgical procedure, potential risk with antimetabolites, and concerns with the management of postoperative complications. We report two case scenarios that highlight the challenges associated with trabeculectomy in pregnant women and the modifications that can be adopted to improve safety and the efficacy of glaucoma filtering surgery during pregnancy.
ABSTRACT
Purpose: To describe the prevalence of various types of childhood glaucomas, their clinical features and treatment methods. Methods: We prospectively included consecutive children with glaucoma presenting to glaucoma clinic for the first time between March 2013 and May 2014. We classified childhood glaucomas as per the classification proposed by Congenital Glaucoma Research Network. Results: Of the 275 children (449 eyes) with glaucoma during this period, primary glaucomas constituted 56% (n = 252 eyes of 145 children), including 169 eyes (37.64%) of 97 children with primary congenital glaucoma (PCG), 16 eyes (3.56%) of 10 children with infantile glaucoma, and 67 eyes (14.9%) of 38 children with juvenile open angle glaucoma. Among these, 85% (214 eyes of 107 children) had bilateral involvement. Secondary glaucomas constituted 44%; they were glaucoma associated with ocular anomalies 18% (n = 80 eyes), glaucoma associated with acquired conditions (steroid induced and traumatic glaucoma) 14% (n = 61 eyes), glaucoma following congenital cataract surgery 7.6% (n = 34 eyes), and glaucoma associated with systemic or syndromic conditions 5% (n = 22 eyes). In primary glaucomas, boys and girls were equally affected (1:1), and more boys (3.8:1) had acquired glaucomas. Close to 80% PCG eyes were managed surgically with combined trabeculotomy and trabeculectomy (CTT). Majority of secondary glaucomas were managed medically. Conclusion: In our cohort, PCG was the most common childhood glaucoma and CTT was the most common surgery performed in these eyes. Steroid-induced and traumatic glaucomas were the most common acquired glaucomas; appropriate measures should be taken to avert these preventable glaucomas in children.
ABSTRACT
Four hundred and thirty three exchange transfusions (ET) for neonatal hyperbilirubinemia in 225 full term (Group I) and 110 premature/low birth weight (Group II) babies were analyzed. A total of 78.5% cases required one, 15.22% two, 4.8% three and 1.5% four ET. In Group I ABO HDN (35.94%), Rh HDN (10.7%), septicemia (8.9%), and G-6-PD deficiency (6.2%) were the major causes. Nearly 20% had multiple factors and in 9.3% no cause was identified. In multifactorial cases 13.3% had septicemia, 17.3% ABO HDN and 6.2% Rh HDN in various combinations. Common causes in Group II babies were septicemia (20.9%), ABO HDN (19.07%), Rh HDN (6.4%) and G-6-PD deficiency (5.4%). Nearly 8% had multifactorial etiology while 30.9% were idiopathic. Complications occurred in 20.4% Group I and 41.8% in Group II babies during ET. Procedure related mortality was 3.2/100 ET which declined to 0.9/100 ET when high risk babies were excluded. Overall mortality in babies subjected to ET was 10.6/100 ET. Cardiorespiratory arrest during procedure (30.4%), septicemia (26.1%) and kernicterus (19.6%) were the leading causes of death. Anemia (23.5% Group I and 50.9% Group II babies) and clinical septicemia (14.2% Group I and 16.4% Group II babies) were major delayed complications.