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Pediatric glaucoma: review of recent literature
Annette Giangiacomo1, Allen Beck
1Emory Eye Center, Emory University, Atlanta, GA, USA.
Insights
Recent advancements in pediatric glaucoma management show successful intraocular pressure (IOP) control with various surgical techniques. Both novel and established methods are considered standard of care for children with glaucoma.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Glaucoma Research
Background:
- Pediatric glaucoma presents unique management challenges.
- Accurate intraocular pressure (IOP) measurement is crucial for diagnosis and monitoring.
Purpose of the Study:
- To provide clinicians with an update on recent developments in pediatric glaucoma.
- To review current surgical and clinical management strategies.
Main Methods:
- Review of recent studies and clinical data on pediatric glaucoma.
- Analysis of outcomes from the Infant Aphakia Treatment Study.
- Evaluation of surgical techniques including trabeculotomy, trabeculectomy, and glaucoma drainage devices.
Main Results:
- iCare tonometer is effective for measuring IOP in children.
- Glaucoma risk is similar in aphakic vs. intraocular lens implanted infants after 5 years.
- Various trabeculotomy and trabeculectomy approaches effectively lower IOP, though visual outcomes for trabeculectomy remain suboptimal.
- Glaucoma drainage devices show moderate success in IOP control, particularly after failed angle surgery.
Conclusions:
- Both new and traditional approaches to pediatric glaucoma management are validated.
- Ongoing evaluation supports current clinical and surgical standards of care for pediatric glaucoma.
Purpose Of Review:
The purpose of this review is to update the clinician on the recent work in the field of pediatric glaucoma.
Recent Findings:
Using the iCare tonometer to measure intraocular pressure (IOP) in children is highly successful. New data from the Infant Aphakia Treatment Study show that after 5 years of follow-up the risk of developing glaucoma is similar between patients that receive initial intraocular lens implantation and those who are left aphakic. New data show effective lowering of IOP using either approach to trabeculotomy: treating the angle partially with trabeculotomes or circumferentially with a suture or iTrack microcatheter. Recent data on an updated approach to trabeculectomy in children show success in lowering IOP with few complications; however, visual outcomes continue to be suboptimal. A separate study shows that the addition of tenonectomy may not increase surgical success, but may increase survival time and reduce bleb encapsulation. Glaucoma drainage devices in general, and the Ahmed implant in particular, continue to be found to be moderately successful to control IOP, and are therefore employed, especially after initial angle surgery has failed.
Summary:
Continued work to evaluate the techniques used in the clinical and surgical management of pediatric glaucoma patients supports that both newer and older approaches remain standard of care.
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