ABSTRACT
INTRODUCTION: Congenital glaucoma is frequently associated with visual impairment due to optic nerve damage, corneal opacities, cataracts and amblyopia. Poor vision in childhood is related to global developmental problems, and referral to vision habilitation/rehabilitation services should be without delay to promote efficient management of the impaired vision. OBJECTIVE: To analyze data concerning visual response, the use of optical correction and prescribed low vision aids in a population of children with congenital glaucoma. METHOD: The authors analyzed data from 100 children with congenital glaucoma to assess best corrected visual acuity, prescribed optical correction and low vision aids. RESULTS: Fifty-five percent of the sample were male, 43 percent female. The mean age was 6.3 years. Two percent presented normal visual acuity levels, 29 percent mild visual impairment, 28 percent moderate visual impairment, 15 percent severe visual impairment, 11 percent profound visual impairment, and 15 percent near blindness. Sixty-eight percent received optical correction for refractive errors. Optical low vision aids were adopted for distance vision in 34 percent of the patients and for near vision in 6 percent. A manual monocular telescopic system with 2.8 × magnification was the most frequently prescribed low vision aid for distance, and for near vision a +38 diopter illuminated stand magnifier was most frequently prescribed. DISCUSSION AND CONCLUSION: Careful low vision assessment and the appropriate prescription of optical corrections and low vision aids are mandatory in children with congenital glaucoma, since this will assist their global development, improving efficiency in daily life activities and promoting social and educational inclusion.
Subject(s)
Adolescent , Child , Female , Humans , Male , Glaucoma/congenital , Refractive Errors/rehabilitation , Sensory Aids , Vision, Low/rehabilitation , Visual Acuity/physiology , Retrospective Studies , Refractive Errors/etiology , Vision, Low/etiologyABSTRACT
OBJECTIVE: To evaluate the safety and effectiveness of trabeculectomy with mitomycin C in the management of childhood glaucoma. INTRODUCTION: The use of antifibrotic agents enhances the success of trabeculectomy performed in both adults and children. METHODS: A retrospective chart review (1991-2001) of 114 patients (114 eyes) from 0-14 years of age with congenital or developmental glaucoma. These patients underwent trabeculectomy with mitomycin but had not been previously treated with any antifibrotic agent. RESULTS: The mean patient age was 57.36 51.14 months (range: 0.5-168 months). Treatment was considered successful in 63 eyes (55.26 percent), with a mean intraocular pressure of 12.11 3.98 mmHg. For patients categorized as successfully treated, the mean follow-up time was 61.16 26.13 months (range 12-113 months). A post-surgical intraocular pressure of < 16 was observed in 47 eyes. The life-table success rates for intraocular pressure control at 24, 36, 48, and 60 months were 90.2 percent, 78.7 percent, 60.7 percent and 50.8 percent, respectively. The cumulative probability of failure was 40.8 percent at 12 months. Following surgery, endophthalmitis appeared in eight eyes (4.88 percent) after an average 36.96 months (range: 1.7-106 months). Other complications included expulsive hemorrhage, flat anterior chamber and bleb leak. DISCUSSION: It has been reported in pediatric patients that trabeculectomy without adjunctive antimetabolites achieves a successful outcome in 30 percent to 50 percent of cases. In our study, treatment was considered successful in 63 eyes (55.26 percent) within 61.16 26.13 months of follow-up. CONCLUSIONS: Trabeculectomy with mitomycin is safe and effective for short-term or long-term treatment of congenital or developmental glaucoma. The frequency of bleb-related endophthalmitis was no higher in these patients than that described in adults.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Antibiotics, Antineoplastic/therapeutic use , Glaucoma/therapy , Mitomycin/therapeutic use , Trabeculectomy , Age Distribution , Combined Modality Therapy , Endophthalmitis/etiology , Follow-Up Studies , Glaucoma/congenital , Intraocular Pressure , Retrospective Studies , Treatment Outcome , Trabeculectomy/adverse effectsABSTRACT
No presente trabalho foram estudadas 80 famílias, perfazendo um total de 184 filhos, sendo 80 portadores de glaucoma congênito. As famílias foram divididas segundo o número de filhos de cada casal e procurou-se verificar em qual dos filhos, segundo a ordem de nascimento, incidiu o glaucoma congênito. Concluiu-se que tais estudos säo pouco informativos. No entanto, entre outros achados, foi observado que o glaucoma congênito ocorreu no primeiro filho em näo mais do que 47,5% dos casos e que a ocorrência da doença em mais de uma vez numa mesma família é esporádica e até certo ponto rara