Profile of childhood glaucoma at a tertiary center in South India

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.

Keywords: Childhood glaucoma in India; South India; childhood glaucomas; congenital glaucoma; prevalence of glaucoma in children; profile of glaucoma in children.

Figure 1

(a) Clinical photograph of a child with bilateral primary congenital glaucoma with acute hydrops in the left eye. (b) A magnified view of the left eye with acute hydrops. (c) Picture of clear corneas 1-month postoperative (after combined trabeculotomy and trabeculectomy). (d) The left eye with clear cornea and Habb's striae

Figure 2

Shows various grades of corneal edema in children with primary congenital glaucoma. Child with bilateral PCG with (a) grade 2 corneal edema, (b) grade 3 corneal edema, (c) grade 4 corneal edema, and (d) grade 5 corneal edema

Figure 3

(a) Clinical photograph of postcongenital cataract surgery glaucoma: 3A: bilateral glaucoma in aphakia. (b) Picture of an eye with pseudophakia and secondary glaucoma

Figure 4

(a) Clinical photograph of a child with bilateral congenital glaucoma, bilateral vascular nevus on the face, and (b) extensive pigmentary nevus on the skin (Phacomatosis pigmentovascularis). (c) External photograph of a child with unilateral Sturge–Weber syndrome (Left-sided facial hemangioma). (d) Right and left eye photographs showing a dark red glow in the left eye suggestive of choroidal hemangioma. (e) Fundus photograph showing diffuse choroidal hemangioma in the left eye

Figure 5

Postoperative photograph of bilateral Axenfeld-Rieger anomaly with congenital glaucoma (a and b), showing prominent Schwalbe's line in both eyes (arrow). Clinical photograph of Aniridia with congenital glaucoma (c), note the Habb's striae and corneal edema. Postoperatve (post-Ahmed glaucoma valve implantation) photograph (d), showing clear cornea with Habb's striae and tube visible superotemporally (arrow). Clinical photograph of bilateral congenital hereditary endothelial dystrophy showing diffuse corneal haze in both the eyes (e), higher magnification showing ground glass appearance of the corneal haze from limbus to limbus (f)

Figure 6

Clinical picture of eye with severe vernal keratoconjunctivitis with limbal thickening (a) and palpebral giant papillae (b) with steroid induced glaucoma. (c) Clinical photograph of the right eye with post traumatic implantation iris cyst and secondary glaucoma. Note the corneal scar from penetrating injury (arrow)