Pediatric Glaucoma-From Screening, Early Detection to Management

Abstract

Pediatric glaucoma (PG) covers a rare and heterogeneous group of diseases with variable causes and presentations. Delayed diagnosis of PG could lead to blindness, bringing emotional and psychological burdens to patients' caregivers. Recent genetic studies identified novel causative genes, which may provide new insight into the etiology of PG. More effective screening strategies could be beneficial for timely diagnosis and treatment. New findings on clinical characteristics and the latest examination instruments have provided additional evidence for diagnosing PG. In addition to IOP-lowering therapy, managing concomitant amblyopia and other associated ocular pathologies is essential to achieve a better visual outcome. Surgical treatment is usually required although medication is often used before surgery. These include angle surgeries, filtering surgeries, minimally invasive glaucoma surgeries, cyclophotocoagulation, and deep sclerectomy. Several advanced surgical therapies have been developed to increase success rates and decrease postoperative complications. Here, we review the classification and diagnosis, etiology, screening, clinical characteristics, examinations, and management of PG.

Keywords: diagnosis; etiology; pediatric glaucoma; screening; treatment.

Figure 1

CGRN classification algorithm for pediatric glaucoma. (Figure courtesy of the Grajewski Lyra (GL) Foundation for Children with Glaucoma. Used with permission.). * Investigator discretion if examination under anesthesia data alone due to the variable effect of anesthesia on all methods of IOP assessment. ** ≥11 mm in a newborn, >12 mm in a child less one year of age, >13 mm at any age.

Figure 2

Clinical photograph of buphthalmos (right eye).