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Purpose: This study aimed to describe visual outcomes in cases of pediatric uveitis in an Indian population and to analyze various factors affecting these outcomes. Methods: Single?center, retrospective chart review of 277 cases of uveitis in patients under the age of 18 years. Variables assessed included age and sex distribution, anatomical location of uveitis, systemic associations, complications, and various treatment strategies used, including long?term immunomodulation and surgical management of complications if required. The main outcome was the final visual acuity. Results: At the final visit, 51.5% of the eyes showed improvement in the final visual acuity, while vision remained stable in 28.7% and 19.7% of the eyes showed worsening of vision at the final follow?up. A total of 19.4% of patients were blind in at least one eye at the final visit, and 16 patients (5.77%) remained bilaterally blind at the final follow?up. The presence of cataract (p = 0), posterior uveitis (p = 0.005), and retinal detachment (p = 0.014) were the most significant risk factors for predicting worse visual outcomes. More than half (65.7%) of patients reported a complication at some point in their follow?up, and the most common complication was cataract. In total, 50.9% of patients required long?term immunomodulatory therapy. Conclusion: Pediatric uveitis remains a challenging condition to treat and follow?up, and the visual outcome remains guarded for most patients. in infectious cataracts, particularly in CMV infections, compared to other cataract subtypes. Tgf? showed significantly low expression in various cataract subtypes, whereas vimentin had elevated gene expression in infectious and prenatal cataracts. Conclusion: A significant association between lens gene expression patterns in phenotypically and etiologically distinct subtypes of pediatric cataracts suggests regulatory mechanisms in cataractogenesis. The data reveal that cataract formation and presentation is a consequence of altered expression of a complex network of genes.
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RESUMEN El tratamiento del glaucoma pediátrico es principalmente quirúrgico. En la actualidad se han creado alternativas para mejorar el éxito de las diferentes técnicas quirúrgicas relacionadas con el glaucoma pediátrico, donde se exige un tratamiento oportuno para poder controlar las presiones intraoculares y rehabilitar precozmente a estos pacientes, ya que muchos de ellos se encuentran en pleno desarrollo visual. De ahí la importancia de realizar una revisión de las principales técnicas quirúrgicas del glaucoma pediátrico(AU)
ABSTRACT Treatment of childhood glaucoma is mainly surgical. New alternatives are presently available to improve the success of the various surgical techniques for childhood glaucoma, a condition requiring timely treatment aimed at intraocular pressure control and quick rehabilitation of these patients, considering that many of them are in full visual development. Hence the importance of conducting a review of the main surgical techniques used for childhood glaucoma(AU)
Subject(s)
Humans , Child, Preschool , Child , Pediatrics , Trabeculectomy/methods , Glaucoma/diagnosisABSTRACT
RESUMEN Se realiza una actualización sobre el diagnóstico y tratamiento del glaucoma infantil primario, considerando la importancia que tiene un diagnóstico precoz y un tratamiento oportuno para obtener los mejores resultados posibles. Actualmente, a pesar del surgimiento de nuevos fármacos y de técnicas quirúrgicas para tratar esta afección, aún existen discrepancias sobre cómo debemos realizar el diagnóstico positivo; qué tratamiento o técnica quirúrgica emplear; cuándo y cuál sería la mejor. Cuando se trata de glaucoma pediátrico (primario o secundario), presente en etapas tan tempranas de la vida -incluso al nacimiento, donde la cirugía está indicada lo más precozmente posible, con la disyuntiva de cuáles medicamentos podemos emplear o no, por desconocimiento de qué efectos indeseables pudieran presentarse en estas edades y además, teniendo en cuenta que estos niños serán nuestros pacientes para toda la vida- es necesario conocer y repasar una vez más este tema. Se recomienda instruir a pediatras y oftalmólogos generales para lograr la remisión adecuada y precoz del niño a un centro especializado para su tratamiento quirúrgico, y mejorar así su pronóstico visual(AU)
ABSTRACT Updated information is provided about the diagnosis and treatment of primary childhood glaucoma, given the importance of early diagnosis and timely treatment to obtain the best possible results. Despite the emergence of new drugs and surgical techniques to treat this disorder, there is still controversy about how we should perform the positive diagnosis, what treatment or surgical technique should be used and when, and which would be the best. When childhood glaucoma (whether primary or secondary) presents at early stages of life - even at birth -, in which case surgery should be indicated as soon as possible, we are faced with the dilemma of what drugs we may or may not use, due to lack of knowledge about undesirable effects which could appear at these ages, and bearing in mind that these children will be our patients for a lifetime. It is thus necessary to be informed about this topic and go over it once again. It is recommended to instruct pediatricians and ophthalmologists to ensure timely, appropriate referral of the child patient to a specialized center where they will receive surgical treatment, thus improving their visual prognosis(AU)
Subject(s)
Humans , Infant , Child, Preschool , Tonometry, Ocular/methods , Trabeculectomy/methods , Ocular Hypertension/etiology , Early Diagnosis , Gonioscopy/methodsABSTRACT
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.
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Objective To investigate the clinical efficacy and safety of microcatheter assisted trabeculectomy on the treatment of childhood glaucoma.Methods A prospective case series method was performed.Sixteen childhood glaucoma with 22 eyes were enrolled in Henan Eye Hospital and Zhengzhou Second People's Hospital from December 2016 to August 2017.Nine males with 12 eyes and 7 females with 10 eyes were included,and the age ranged from 6 months to 8 years (median 4 years).All the subjects underwent microcatheter assisted trabeculectomy.The intraocular pressure changes were observed preoperation and 7 days,1 month and 6 months after surgery,and the postoperative complications were analyzed.This study was approved by the Ethics Committee of Henan Eye Hospital (2018KS-01) and Zhengzhou Secord People's Hospital (No.20161202001),and adhered to the tenets of the Declaration of Helsinki.Written informed consent was obtained from each guardia prior to any medical examination.Results Twenty eyes of 14 patients underwent microcatheter assisted trabeculectomy,the success rate was 90.91％.Twelve eyes were operated with full incision (incision range was 360°),8 eyes were performed with subtotal incision (incision range was 180°-330°),while the microcatheter could not pass over 90° in 2 eyes and was switch to traditional Harms knife trabeculotomy-trabeculectomy intraoperatively.The intraocular pressures of the 20 eyes that underwent microcatheter assisted trabeculectomy preoperation,7 days,1 month and 6 months after surgery were (26.55 ±4.38),(20.48 ± 3.62),(13.71 ± 6.35) and (12.67 ± 5.37) mmHg,respectively.The intraocular pressures in patients at different time points were statistically significant (F=112.771,P＜0.001).At the last follow-up,the intraocular pressures of 18 eyes were controlled.Among them,16 eyes achieved completely controlled intraocular pressure while 2 eyes returned to normal intraocular pressure after using ocular hypotensive drugs.The intraocular pressure of 2 eyes increased again after operation,and the intraocular pressure could not be controlled after combined use of anti-hypertensive drugs.All patients had no serious complications during and after the operation.Different degrees of anterior chamber hemorrhage occurred in 16 eyes during the surgery,and all the hemorrhages were absorbed within 1 week after surgery.Conclusions For children with glaucoma,microcatheter assisted trabeculectomy can achieve good intraocular pressure reduction effect without serious complications.
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A wide range of rare eye diseases can be summarized into two categories, namely, the primary rare eye diseases and rare syndrome with ocular manifestations. Among rare eye diseases, childhood glaucoma is more common, which has caused about 8% of blindness in the pediatric population. Childhood glaucoma associated with rare diseases is classified in primary and secondary glaucoma. The secondary glaucoma is divided as glaucoma arising in neural crest anomalies, phakomatoses, metabolic diseases, mitotic disorders, congenital and/or acquired conditions. Medicine and surgery are two major managements of childhood glaucoma. This paper reviews the epidemiology, pathophysiogenesis, and management of childhood glaucoma.
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Purpose: To evaluate the Childhood Glaucoma Research Network (CGRN) classification system and describe the prevalence of each subtype according to this classification. Materials and Methods: Retrospectively, the medical records of 205 consecutive childhood glaucoma and glaucoma suspect patients at an urban tertiary care center were reviewed. The initial diagnosis and new diagnosis according to CGRN classification were recorded. Results: All patients fit one of the seven categories of the new classification. Seventy‑one percent of diagnoses were changed upon reclassification. Twenty‑three percent of patients had primary glaucoma (juvenile open‑angle glaucoma and primary congenital glaucoma [PCG]); 36% had secondary glaucoma (glaucoma associated with nonacquired ocular anomalies; glaucoma associated with nonacquired systemic disease or syndrome; glaucoma associated with acquired condition; and glaucoma following cataract surgery); and 39% were glaucoma suspect. Of the patients diagnosed with glaucoma, PCG was the most common diagnosis, seen in 32% of patients. Conclusion: The CGRN classification provides a useful method of classifying childhood glaucoma.
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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.