Childhood Angle Closure: Etiology and Treatment Outcomes from a Large Series Spanning over 20 Years

To characterize the etiologies of childhood angle closure (CAC) and to compare the long-term outcomes of glaucoma drainage devices (GDDs) vs. lens surgery ± goniosynechialysis (GSL) in the management of CAC-associated glaucoma.

Retrospective multicenter cohort study.

Patients under 18 years of age diagnosed with CAC between 2003 and 2023.

Childhood angle-closure cases were categorized by acute vs. chronic presentation and by primary vs. secondary causes. Treatment approaches were analyzed, and surgical outcomes of GDD implantation and lens extraction ± GSL were compared in CAC glaucoma, excluding cases of glaucoma following cataract surgery (GFCS).

The primary outcome was the distribution of CAC etiologies in pediatric patients. The secondary outcomes included the 5-year complete and qualified success rates of GDDs and lens surgery ± GSL in CAC glaucoma, changes in intraocular pressure, and the number of glaucoma medications required postoperatively.

A total of 103 patients (159 eyes) were included, with a slight female predominance (51.5%) and a mean age at diagnosis of 10.3 ± 5.6 years. Acute CAC was observed in 5.7% of eyes, all of which were secondary. The remaining 94.3% had chronic CAC, most associated with retinopathy of prematurity (ROP, 26.7%). Among those with glaucoma, ROP was the leading cause (21.9%), followed by GFCS (16.0%) and uveitis (7.6%). Surgical intervention was required in 63.3% of CAC glaucoma cases, with GDD implantation being the most frequent (38.6%), followed by lens surgery (22.7%, 85% of which included GSL), peripheral iridotomy (15.9%), and trabeculectomy (7.9%). Lens surgery ± GSL demonstrated a significantly higher complete success rate at 5 years compared to GDD (35.5% vs. 9.5%; P = 0.006), while no significant differences were found in qualified success (P = 0.2) or serious surgical complications between the 2 groups.

Childhood angle closure is primarily chronic and secondary, most often associated with ROP. Surgical intervention is frequently required in CAC-related glaucoma. Our findings suggest that lens surgery ± GSL may achieve superior long-term complete success compared to GDDs, with a comparable safety profile. However, given the multiple etiologies of glaucoma, the choice of surgical approach should be individualized and guided by the underlying etiology and clinical judgment FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.