Childhood glaucoma 1. Primary congenital infantile 2. Glaucoma
associated with congenital anomalies 3. Glaucoma secondary to other
ocular pathology
Slide 4
Mechanisms of glaucoma in childhood are often different from
those seen in older patients successful management of childhood
glaucoma will be difficult without the cooperation and help of well
informed parents
Slide 5
Primary congenital glaucoma. Primary newborn congenital
glaucoma most sever clinically apparent between birth and age one
month.Primary infantile between one month and two years. Juvenile
after age of two years Primary congenital glaucoma. Primary newborn
congenital glaucoma most sever clinically apparent between birth
and age one month.Primary infantile between one month and two
years. Juvenile after age of two years
Slide 6
PCG Characterized by developmental defects of TM and anterior
chamber angle prevent adequate drainage of aqueous humor
Characterized by developmental defects of TM and anterior chamber
angle prevent adequate drainage of aqueous humor 65% male 65% male
70% bilateral 70% bilateral The earlier the onset - the worse
prognosis The earlier the onset - the worse prognosis Optic nerve
cupping in infants and young children is reversible particularly in
the early stages of the disease Optic nerve cupping in infants and
young children is reversible particularly in the early stages of
the disease Amblyopia treatment is essential Amblyopia treatment is
essential
Slide 7
clinical diagnosis of newborn & infantile P C G clinical
diagnosis of newborn & infantile P C G Elevated IOP Elevated
IOP Enlargement globe Buphthlamos usually dose not occur after age
of 3-4 years Enlargement globe Buphthlamos usually dose not occur
after age of 3-4 years Increased corneal diameter Increased corneal
diameter Deep Ant.chamber Deep Ant.chamber Photophobia Photophobia
Thinning of the Ant. Sclera and iris atrophy Thinning of the Ant.
Sclera and iris atrophy Progressive optic atrophy Progressive optic
atrophy Absence of structural changes in Ant.chamber Absence of
structural changes in Ant.chamber
Slide 8
Childhood galucoma 1- PCG 2-Glaucoma associated with congenital
anomalies A. Aniridia 1- complete 2- partial - irishypoplasia B.
Anterior segment dysgensis syndromes - peters anomaly C. Lowe
syndrome - oculocerebral syndrome E. Neurofibromatosis F. Sturge
Weber syndrome G. Nance Horn syndrome - cat. Micro cornea &
skeletal defects H. Glaucoma a secondary to other ocular
pathology
Slide 9
Evaluation following diagnosis 1- measurement of IOP with the
first few minutes of anesthesia - barbiturates & narcotics
before examination is contraindicated 2-measurement of corneal
diameter a) From nasal limbus to temporal limbus b) Its valuable
infants and children under 2 years of age c) Normal range ( 9.50 to
10mm) 3) Examination of the anterior segment 4) Ophtholmoscopy a)
best direct ophthalmoscopy b) B)cupping, vessels appears similar to
adults 5) Gonioscopy
Slide 10
Management Goal of treatment is decrease IOP Goal of treatment
is decrease IOP Early treatment will reveres some of complications
in children Early treatment will reveres some of complications in
children PCG is almost always managed surgically PCG is almost
always managed surgically More than one surgical intervention may
be necessary to control IOP More than one surgical intervention may
be necessary to control IOP
Slide 11
SURGICAL TREATMENT PCG almost always managed surgically PCG
almost always managed surgically Goal of surgery is to eliminate
the resistance to aqueous out flow caused by structural
abnormalities in angle Goal of surgery is to eliminate the
resistance to aqueous out flow caused by structural abnormalities
in angle
Slide 12
Surgical treatment 1) Internal approach goniotomy 2) External
approach a) Trabeculotomy b) Traculectomy 3 Drainage implants 4)
cyclodestruction
Slide 13
Medications Surgery should not be delayed Surgery should not be
delayed Preoperative Medication Preoperative Medication 1) Reduce
the risk of sudden decompression 2) To clear the corneal for better
visualization during examination and surgery
Slide 14
Medications 1) Beta blockers ( timolol ) 2)
Parasympathomimetics ( pilo) 3) Carbonic anhydrase inhibitors 4)
Prostagalandin agonists Alpha 2 agonists Brimonidine should be
avoided in children Risk of apena and bradycardia
Slide 15
Treatment of refractive errors & amblyopia in children Is
something special in management of childhood glaucoma
Slide 16
Genetic mode of inheritance PCG caused by ( cy p1 B1) autosomal
recessive PCG caused by ( cy p1 B1) autosomal recessive 1) each sib
of an affected individual has: 1) each sib of an affected
individual has: 25% chance of affected 25% chance of affected 50%
asymptomatic carrier 50% asymptomatic carrier 25% chance of being
unaffected and not a carrier 25% chance of being unaffected and not
a carrier
Slide 17
Visual acuity children with glaucoma 1) Goals of managing
glaucoma are to promote development of a) Visual acuity b) Visual
field 2) We have difficulty in assessing VA, VF, IOP & optic
disc head in infants and young children 3) Overall prognosis for
vision is poor in 200 cases : 30% good visual acuity 25% fair 45%
poor
Slide 18
To get VA the simplest fixation in infants Allen cards and
Snellen chart starting at 4 years To get VA the simplest fixation
in infants Allen cards and Snellen chart starting at 4 years IOP
measured by aplanation tonometery Perkins or goldman ( EUA or by
topical anesthesia ) - tonopen more accurateschiotz tonometer -
pneumotonometer IOP measured by aplanation tonometery Perkins or
goldman ( EUA or by topical anesthesia ) - tonopen more
accurateschiotz tonometer - pneumotonometer central corneal
thickness by pachmate instruments central corneal thickness by
pachmate instruments IOP 19mm Hg considered to be in good control
IOP 19mm Hg considered to be in good control
Accuracy of measurement of IOP depend on 1) instrumentation
used 2) 2) thickness of the central cornea
Slide 21
Amblyopia Was present in all groups Was present in all groups
The most common reason for decreased VA The most common reason for
decreased VA ophthalmologist must be very persistent with amblyopia
especially during the early years of life ophthalmologist must be
very persistent with amblyopia especially during the early years of
life OCT - Heidelberg retinal tomography scanning laser polarimetry
for evaluation of optic disc retinal nerve fiber damage should be
used in cooperative children OCT - Heidelberg retinal tomography
scanning laser polarimetry for evaluation of optic disc retinal
nerve fiber damage should be used in cooperative children
