Demographic profile, management approaches, and outcome analysis of secondary childhood glaucoma in a tertiary eye care hospital in northern India
Year: 2025
Type: article
Study design: Observational Study
Abstract: Secondary childhood glaucomas contribute significantly to visual morbidity in pediatric patients affected by glaucoma and are frequently undiagnosed.[1] The prevalence of secondary glaucoma in North India has been cited to be between 6 to 22%.[2] The Indian childhood glaucoma study, which included 13 centers across India, found that 53.4% of childhood glaucoma cases were secondary.[3] In this retrospective study, we analyzed records of 115 pediatric patients who visited glaucoma clinic from March 2019 to September 2022. We assessed demographic data, best-corrected visual acuity, intraocular pressure, slit lamp, and fundus findings, as well as diagnosis according to the Childhood Glaucoma Research Network (CGRN) Classification. We documented medical and surgical management approaches, evaluating outcomes in terms of complete success, qualified success, and failure. A total of 156 eyes of 115 patients were analyzed. The primary causes were acquired conditions, the most prevalent being glaucoma following vitreoretinal surgery, followed by glaucoma associated with blunt trauma, steroid-induced glaucoma, glaucoma post-penetrating keratoplasty, and glaucoma post-uveitis. Among non-acquired ocular anomalies, Axenfeld-Rieger syndrome was the most common, followed by aniridia, Peters anomaly, microcornea, ectropion Uveae, and persistent hyperplastic primary vitreous. Glaucoma associated with non-acquired systemic anomalies was most common in Sturge-Weber syndrome, followed by neurofibromatosis type 1. Glaucoma following cataract surgery affected 24 eyes of 19 patients (16.52%). Glaucoma following cataract surgery was most common in the age group of less than five years. Traumatic glaucoma and glaucoma post-vitreoretinal surgery were the most common types observed in all other age groups, affecting 17 and nine patients, respectively. Medical management was utilized in 52.56% of cases, while surgical intervention was performed in 47.44%. Trabeculectomy was the most common surgery performed in glaucomas due to acquired causes (65.71%) and glaucoma in non-acquired ocular anomalies (68%) [Table 1]. Implants were more commonly used (54.55%) in glaucoma after cataract surgeries. A total of five out of eight cases of glaucoma associated with non-acquired systemic anomalies were managed conservatively with anti-glaucoma medications. Transscleral cytophoto coagulation was not considered as the primary surgical procedure for any secondary glaucoma subtype. There was no statistically significant difference (P = 0.92) in selecting the management options for glaucoma, as almost a similar number of eyes received medical and surgical management. The outcomes of all three procedures, namely implants, trabeculectomy, and trabeculectomy + trabeculotomy, were not statistically significant (P = 0.43) [Table 2].Table 1: Surgical management of various types of secondary childhood glaucomaTable 2: Comparison of surgical outcomesOverall success was achieved in 80.55% of patients, while 19.45% experienced failure six months post-surgery. Three eyes with AR syndrome, two eyes with aniridia, one eye with PHPV, one eye with NF1, one eye with steroid-induced glaucoma, three eyes post-vitreoretinal surgery, and two eyes following cataract surgery failed. No major sight-threatening surgical complications were reported. While primary childhood glaucomas have received considerable attention, there remains a lack of understanding regarding optimal management strategies for secondary cases.[4] This knowledge gap emphasizes the need for the development of effective management and treatment approaches tailored to the unique characteristics of secondary childhood glaucomas. Timely identification and management of secondary childhood glaucoma are crucial in enhancing visual prognosis and quality of life for pediatric patients.
Source: Indian Journal of Ophthalmology
Authors: Suneeta Dubey, Parul Bansal, Julie Pegu
Institution: Dr. Shroff’s Charity Eye Hospital
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4407836449