Costenbader Lecture Glaucoma in Children: Are We Maki Progres

Background: Glaucoma in children presents difficult clinical challenges. Even when appropriately tr blindness can occur. Design: Retrospective interventional case series and literature review. Methods: All c records of children seen by the author with a diagnosis of glaucoma established before 16 years of age were rev from 1977 to 2003. Glaucoma was classified as primary infantile, aphakic, syndrome-related, and secondary best-corrected visual acuity, refractive error, configuration of the optic nerve cup, and perimetry were recorde intraocular pressure (IOP) for each visit was recorded. IOP measurements of 19 mm Hg or less were considered “g The percentage of “good” readings was calculated for each eye. Representative visual acuities, refractive error disk configuration, and perimetry were recorded at 6, 12, 18, and 24 years of age for each patient. The adm ophthalmologic diagnosis for each child at the Western Pennsylvania School for Blind Children was recorded from to 2003. Results: One hundred twenty-six children (204 eyes) were studied: infantile glaucoma, 52 eyes; ap glaucoma, 40 eyes; syndrome associated, 69 eyes; and secondary glaucoma, 43 eyes. The mean follow-u 11.6 years (1 to 30 years). Overall, 60 (29.4%) of 204 eyes had a 6/12 (20/40) or better corrected visual acuity most recent visit. The percentage with this acuity remained stable throughout the follow-up period. Eyes infantile glaucoma had the best acuity, and 40% had 6/12 (20/40) or better. Amblyopia was common and resp to treatment. Eyes with aphakic glaucoma had the worst acuity with only 10% achieving 6/12 or better. These had a bimodal onset of glaucoma; eyes with an early onset had an angle closure configuration and eyes w delayed onset had an open angle. Early cataract removal and microcornea were risk factors for glaucoma. IOP was maintained at 19 mm Hg or less (good) on 80% of the determinations over time, the optic nerv compared with the diameter of the optic nerve (C/D ratios) were stable. Eight patients had multiple, good q visual fields performed over 3 to 15 years. If the patients had “good” IOP on 70% of the measurements, the fields remained stable. A historical perspective of glaucoma control was gained by looking at the adm diagnosis at the Western Pennsylvania School for Blind Children. From 1910 to 1970, an average of 9.2 ch blind due to glaucoma were admitted each decade. From 1971 to 2003, there were only three children glaucoma admitted over 30 years. Conclusion: Removal of congenital cataracts should be delayed until 3 to 4 w of age. Consideration should be given for using 19 mm Hg or less to measure the success of glaucoma treatm children. Treatment of amblyopia is as important as IOP control in children. Imaging technology such as o coherence tomography and measurement of central corneal thickness may play an important future role assessment of children with suspected or known glaucoma. (J AAPOS 2006;10:7-21)