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The epidemiology of pediatric glaucoma: the Toronto experience
R H Taylor1, J R Ainsworth, A R Evans
1York District Hospital, United Kingdom.
Insights
Pediatric glaucoma outcomes vary significantly by diagnosis. Congenital glaucoma, the most common type, showed variable visual performance, while some subtypes like steroid-induced glaucoma had good outcomes.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Genetics
Background:
- Glaucoma in children presents a unique challenge with diverse etiologies.
- Understanding the spectrum of pediatric glaucoma is crucial for effective management.
- This study represents the largest single-population analysis of pediatric glaucoma to date.
Purpose of the Study:
- To investigate the spectrum of glaucoma in pediatric patients.
- To compare disease control success rates across different glaucoma subtypes.
- To evaluate the visual prognosis associated with various pediatric glaucoma diagnoses.
Main Methods:
- Retrospective chart review of 306 children diagnosed with glaucoma between birth and 16 years.
- Inclusion criteria: first seen between January 1974 and January 1995 at the Hospital for Sick Children.
- Data analysis focused on diagnostic subgroups, surgical interventions, and visual outcomes.
Main Results:
- Congenital glaucoma was the most frequent subtype (38%), often requiring multiple surgeries, with goniotomy achieving a cure in 47.8%.
- Aphakic glaucoma (20%) presented later and had a 50% surgical intervention rate.
- Poor visual outcomes were linked to aniridia, anterior segment dysgenesis, uveitis, retinopathy of prematurity, and PHPV; steroid-induced glaucoma and anterior segment dysgenesis showed good prognoses.
Conclusions:
- Childhood glaucoma management and visual prognosis are highly variable.
- Specific diagnostic categories demonstrate consistently good or poor outcomes, guiding clinical expectations and treatment strategies.
Background:
This study was conceived to provide an insight into the spectrum of glaucoma in the pediatric population. We also set out to compare the success of disease control and the prognosis for vision within the different diagnostic subgroups. This is the largest single population of children with glaucoma that has been so described and compared.
Methods:
The charts of children who were first seen between birth and age 16 years and who attended the Hospital for Sick Children with any form of glaucoma between January 1974 and January 1995 were reviewed and entered into the study.
Results:
Data are presented for 306 children. Congenital glaucoma was the most common subtype, accounting for 38%. Patients with congenital glaucoma were young, had surgery, and had more operations than any other group except those with aniridia. Goniotomy offered a cure in 47.8% of the patients. A bimodal distribution reflected their visual performance. Patients with aphakic glaucoma, the next most prevalent group (20%), presented at an older age (4.5 years). Surgical intervention was performed in 50% of these children. Nearly all patients with Sturge-Weber syndrome (80%) had surgery. The following glaucoma groups were associated with a poor visual outcome: aniridia, anterior segment developmental anomalies involving the cornea, uveitis with glaucoma other than steroid induced, retinopathy of prematurity, and persistent hyperplastic primary vitreous. Steroid-induced glaucoma and anterior segment dysgenesis, excluding Peters anomaly, had uniformly good outcomes.
Conclusion:
The ability to control glaucoma in childhood and visual prognosis is highly variable. Particular diagnostic categories do consistently well and some do poorly.