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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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Purpose: To assess the clinical presentation of pediatric patients having early traumatic glaucoma and to analyze early predictors for the need of filtration surgery. Methods: Patients with early traumatic glaucoma after close globe injury (CGI) from January 2014 to December 2020 were retrospectively reviewed. Clinical features, treatment provided (medical and surgical), and visual outcomes were documented. Patients were divided into two groups based on the management required: group A? trabeculectomy and group B? medication + minor surgery. Results: A total of 85 patients were studied after applying the necessary inclusion and exclusion criteria. Out of these, 46 underwent trabeculectomy for the control of intraocular pressure (IOP) and the remaining 39 were managed with antiglaucoma medications. Significant male predominance of 9.6:1 was observed. Patients presented to the hospital after a mean duration of 8.5 days posttrauma. Wooden objects were most commonly responsible for trauma. Mean best corrected visual acuity at presentation was 1.91 log of minimum angle of resolution (logMAR). Mean IOP at presentation was 40 mmHg. The common anterior segment finding were severe anterior chamber (AC) reaction (63.5%), followed by angle recession (56.4%). Severe AC reaction (P = 0.0001) and corneal microcystic edema (P = 0.04) were significant predictive factors for early need of trabeculectomy. Conclusion: Need of trabeculectomy was higher in patients with severe AC reaction and corneal microcystic edema. The threshold to perform trabeculectomy should be lower, as glaucoma is often relentless, severe, and may result in irreversible vision loss.
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Purpose: To determine surgical outcomes and risk factors for failure of trabeculectomy with mitomycin C (TMMC) in pediatric traumatic glaucoma. Methods: Children who underwent TMMC post trauma from January 2014 to December 2019 were reviewed. Demographic features, ocular findings, and surgery details were noted. Surgical success was defined as achieving intraocular pressure (IOP) within 6–21 mm Hg. Results: Seventy?one eyes of seventy patients underwent TMMC. The mean age of the patients was 11.28 ± 3.63 years with a male/female ratio of 13:1. The median time from trauma to IOP rise was 13 days. The majority of the patients (n = 64, 90.1%) had close globe injury. Baseline IOP was 39.3 ± 10.5 mm Hg. Results of the surgery were noted at the last visit. Cumulative success was noted in 51 (71.8%) eyes, while 20 (28.2%) eyes were labeled failures. Mean IOP reduced from 39.3 ± 10.5 to 14.5 ± 8.1 mm Hg. Mean visual acuity improved from 2.3 ± 0.93 to 1.19 ± 1.08 logMAR. Post surgery, the mean follow?up of the patients was 20.3 ± 11.4 months. Age <6 years (RR 3.6), elevated IOP at 1 month after TMMC (RR 2.19), and hypotony within a week of surgery (RR 1.81) were found as independent risk factors of surgical failure. Conclusion: TMMC is effective in reducing IOP in traumatic glaucoma. Young age and inability to control IOP within normal ranges in the immediate period after surgery are important risk factors of failure.
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The circumpapillary retinal nerve fiber layer (RNFL) thickness was assessed by spectral domain optical coherent tomography (SD-OCT) before and after surgical reduction of intraocular pressure in an eye with primary infantile glaucoma. In this case, a postoperative reduction of cupping and a subsequent increase in neuroretinal rim area is associated with a paradoxical thinning of the RNFL. This is the first-known characterization of cupping reversal using SD-OCT.
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Objetivo: Caracterizar los pacientes atendidos por glaucoma pediátrico, identificar el tratamiento más utilizado para cada subgrupo y conocer los resultados en referencia al control de la presión intraocular. Método: Estudio retrospectivo mediante revisión de historias clínicas de pacientes con glaucoma pediátrico menores de 15 años, pertenecientes al servicio de oftalmopediatría de la Fundación Oftalmológica de Santander Clínica Carlos Ardilla Lülle, atendidos entre enero/2001 y diciembre/2006. Resultados: Del total de casos recolectados, 46 pacientes tenían glaucoma congénito primario, 15 pacientes con glaucoma del desarrollo y 21 pacientes con glaucoma secundario. La técnica quirúrgica más utilizada fue la trabeculotomía combinada con trabeculectomía (TCO+TCE), seguido por la trabeculectomia aumentada con mitomicina (TCE+MMC) y el tratamiento médico tópico con hipotensores oculares. Conclusiones: El glaucoma congénito primario es la causa más frecuente de glaucoma en niños y la técnica combinada de TCE+TCO es el procedimiento de elección con una tasa de éxito del 69.6%.
Background: Glaucoma infrequently affects infants and children, as compared with adults. The prognosis of any glaucoma is better if it is diagnosed early and brought under control. In our experience, primary congenital glaucoma is the most common paediatric glaucoma, and for this condition, combined trabeculotomy+trabeculectomy is the procedure of choice. Objective: To characterize patients seen with paediatric glaucoma, to identify the most often used treatment for each subgroup and the results in reference to the intraocular pressure control. Method: Retrospective clinical record review of paediatric patients with glaucoma under 15 years old, treated in Oftalmopediatrics Service of the Ophthalmologic Foundation of Santander Carlos Ardila Lülle Clinic attended from January/2001 to December/2006. Results: 46 patients had primary congenital glaucoma, 15 had developmental glaucoma, and 21 had secondary glaucoma. The surgical technique most frequently used was trabeculotomy combined with the trabeculectomy (TCO + TCE), followed by trabeculectomy augmented with mitomycin (MMC + TEC) and medical treatment topic with ocular hypotensive. Conclusions: The primary congenital glaucoma is the most frequent cause of glaucoma in children and the combined technique TEC + TCI is the procedure of choice with success rate of 69.9%.