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Childhood glaucoma profile in a Southwestern Ethiopia tertiary care center: a retrospective study
Tarekegn Mulugeta1, Guteta Gebremichael2, Sufa Adugna2
1Department of Ophthalmology, Institute of Health, Jimma University, Jimma, Ethiopia. zermestar@gmail.com.
Insights
Childhood glaucoma, a leading cause of childhood blindness, was characterized in sub-Saharan Africa. Primary congenital glaucoma (PCG) was most common, with most eyes managed surgically and 85.3% achieving successful intraocular pressure control.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Public Health
Background:
- Childhood glaucoma is a significant global cause of pediatric blindness.
- Characterization of childhood glaucoma in sub-Saharan Africa is limited.
- This study aimed to describe the demographics, clinical features, and management of childhood glaucoma in the region.
Purpose of the Study:
- To characterize the demographics and clinical features of childhood glaucoma in sub-Saharan Africa.
- To evaluate the management strategies and outcomes, including visual acuity and intraocular pressure (IOP) control.
- To identify the most common types of primary and secondary childhood glaucoma.
Main Methods:
- Retrospective study of 105 children (181 eyes) diagnosed with glaucoma between September 2019 and August 2022.
- Diagnosis and classification followed the Childhood Glaucoma Research Network (CGRN) criteria.
- Data collected included demographics, glaucoma type, management, and IOP/visual acuity outcomes.
Main Results:
- Primary congenital glaucoma (PCG) was the most frequent type (42%), followed by glaucoma suspect (22.1%) and juvenile open-angle glaucoma (JOAG) (15.5%).
- Boys were more affected than girls (2:1 for primary, 2.7:1 for secondary glaucoma).
- 85.3% of eyes achieved successful IOP control (≤21 mmHg); 93.4% of PCG eyes underwent surgery, primarily combined trabeculotomy and trabeculectomy (CTT).
Conclusions:
- PCG is the predominant form of childhood glaucoma in this sub-Saharan African cohort.
- Late presentation of PCG, a challenge in developing countries, was observed, underscoring the need for increased eye-care access and awareness.
- Steroid-induced glaucoma was the most common secondary type, highlighting the importance of preventative measures.
Background:
Childhood glaucoma is a major cause of childhood blindness worldwide. The profile of childhood glaucoma has not been well characterized in sub-Saharan Africa. Thus, this study was designed to describe demographics, clinical features, managements of childhood glaucoma, and improvements in visual acuity (VA) and intraocular pressure (IOP) from baseline to final visit.
Methods:
This retrospective study included glaucoma patients below 18 years old who were diagnosed between September 2019 to August 2022. Childhood glaucoma diagnosis and classification was made as per the Childhood Glaucoma Research Network Classification (CGRN).
Results:
A total of 105 children (181 eyes) were diagnosed with glaucoma. The most common type of childhood glaucoma was primary congenital glaucoma (PCG) constituting (42%, n = 76 eyes, 95% confidence interval (CI), 34.7-49.5%; P = 0.037), followed by glaucoma suspect (22.1%, n = 40 eyes, 95% CI, 16.3-28.9%; P < 0.001) and juvenile open-angle glaucoma (JOAG) (15.5%, n = 28 eyes, 95% CI, 10.5-21.6%; P < 0.001). While the most common type of secondary glaucoma was steroid-induced glaucoma, followed by glaucoma following cataract surgery. Bilateral glaucoma was found in 72.4% (n = 76 children, 95% CI, 62.8-80.7%; P < 0.001) of children. In both primary and secondary glaucoma, boys were affected more than girls, in ratio of 2:1 and 2.7:1, respectively. The mean age at presentation for patients with PCG was 2.7 years. Close to 93.4% (71) of PCG eyes were managed surgically, of which majority underwent combined trabeculotomy and trabeculectomy (CTT). Most of secondary glaucoma cases were treated medically. Overall, 85.3% (111) of eyes had successful control of IOP ≤ 21 mmHg.
Conclusion:
PCG was the most common type of childhood glaucoma. One of a well-recognized challenge in developing countries, late presentation of patients with PCG, was also observed in our study. Which highlights, the need of increasing access to eye-care service and awareness of childhood glaucoma as a major public health issue. Steroid-induced glaucoma was the most common type of secondary glaucoma; appropriate measures should be taken to prevent this preventable glaucoma.
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