Central Corneal Thickness in Aphakic Children With Microcornea-Microphthalmia

Secondary intervention after failed initial intervention for primary congenital glaucoma

AIM

To report on the outcome of subsequent interventions after failed initial intervention for primary congenital glaucoma (PCG).

METHODS

Retrospective chart review of children presenting with PCG and failed the initial glaucoma surgery in Alexandria Main University Hospital from 2005 to 2017. The data included demographics, preoperative, operative and postoperative clinical characteristics. Success was defined as IOP<16mmHg and <20% from the presenting IOP and C/D ratio like or better than presentation.

RESULTS

The charts of 531 (260 right, 49%) eyes of 360 (224 males, 62%) children presenting with PCG and failed the initial glaucoma surgery (58 [31 right, 53%] eyes [10.9%] of 50 [28 males, 56%] children) revealed that at initial presentation, the mean±standard deviation (range, median) of the age of the children subjected to one successful glaucoma procedure and the study children was 8.6±11.7 (0.6-109, 5.2) and 4.9±6.1 (0.5-34.4, 3.0) months, respectively. Each of the study eyes was subjected to 2.6±0.8 (2-5.2) glaucoma procedures. The mean±standard deviation (range, median) duration between the initial and second glaucoma surgery and the duration of follow-up was 6.9±7.8 (0.7-39,3.9) and 61.5±32.1 (12.0-139.1, 60.1) months, respectively. At the final follow-up visit success was reported in 41 (70.1%) eyes by IOP<16mmHg criterion, 39 (67.2%) eyes by IOP>20% reduction criterion and in 28 (out of 35 eyes, 80.0%) by the optic nerve condition (C/D ratio) criterion. Success by all 3 criteria was reported in 25 (out of 35 eyes, 71%) eyes.

CONCLUSIONS

A repeat glaucoma surgical procedure maybe needed in up to 11% of operated PCG eyes, with the subsequent glaucoma surgical procedures being successful by about 70%.

Pediatric glaucoma in aniridia in a population of Egyptian children

PURPOSE

To report on the incidence, characteristics, and treatment of glaucoma in association with aniridia in a population of Egyptian children.

METHODS

A retrospective chart review was conducted of children (<18 years of age) presenting with aniridia between 2007 and 2022. Diagnosis of glaucoma was based on cup:disk ratio (>0.3) and IOP (>16 mm Hg). Success of glaucoma surgery was defined as IOP ≤16 mm Hg and stable or regressing cup:disk ratio.

RESULTS

A total of 93 eyes of 47 children were included. The mean patient age at presentation was 41.2 ± 44.7 months. The mean intraocular pressure (IOP), corneal diameter, cup:disk ratio, and axial length on presentation were 16.4 ± 10.3 mm Hg, 11.4 ± 1.3 mm, 0.4 ± 0.3, and 22.43 ± 2.6 mm Hg. Of eyes with IOP and cup:disk ratio data at presentation, 23 (30%) were diagnosed with glaucoma. Fourteen eyes underwent surgery after presentation; follow-up data were available for half the remaining eyes. At the final follow-up, glaucoma was present in 20 eyes (49%). Glaucoma surgery was performed in 17 eyes, with a complete or qualified success rate of 82.4% at final follow-up, with 15 eyes having at least 12 months' follow-up.

CONCLUSIONS

In this study cohort, children with aniridia presented at around 3 years of age, with glaucoma at presentation in almost one-third of the cases.

Corneal Biometric Parameters and Refractive Properties in Microcornea With Normal Axial Length

PURPOSE

The purpose of this study was to evaluate the features of and relationships among corneal diameter, central corneal thickness (CCT), endothelial cell density (ECD), and corneal refractive properties in cases of microcornea (MC) with normal axial length.

METHODS

We included 22 patients (35 eyes) with MC and cataracts and 41 patients (48 eyes) with isolated cataracts as age-matched controls. They were divided into patients with MC younger than 18 years (MC-child), patients with MC 18 years or older (MC-adult), children with congenital cataracts (CCs), and adults with senile cataracts (SCs). Corneal diameter, axial and anterior chamber length, and keratometry were measured; central corneal endothelial cell imaging was performed.

RESULTS

The mean horizontal corneal diameter was 7.71 ± 1.51 and 8.78 ± 0.52 mm in MC-child and MC-adult groups, respectively, and 11.89 ± 0.59 and 11.52 ± 2.42 mm in child and adult controls, respectively. The mean CCT was 641.26 ± 63.37 (MC-child) and 617.38 ± 45.40 mm (MC-adult), and 554.92 ± 34.64 (CC) and 551.58 ± 28.47 mm (SC). The mean ECD was 2898.47 ± 443.90 (MC-child) and 2825.81 ± 484.65 cells/mm 2 (MC-adult), and 3155.13 ± 372.67 (CC) and 2749.33 ± 399.63 cells/mm 2 (SC). The average keratometry was 44.22 ± 3.14 D (MC-child) and 43.86 ± 2.59 D (MC-adult), and 44.19 ± 1.44 D (CC) and 43.94 ± 1.34 D (SC).

CONCLUSIONS

Patients with MC and normal axial length possess specific parameters, including significantly smaller corneal diameter and thicker CCT than the patients in the control groups. There were no significant differences in ECD and average keratometry. These parameters should be taken into account in the follow-up and treatment.

Glaucoma in children with facial port wine stain

PURPOSE

To report on the clinical presentation and surgical treatment (procedure and outcome(s)) of glaucoma in children with facial port wine stain.

MATERIALS AND METHODS

This is a retrospective chart review of children with facial port wine stain referred to Alexandria University paediatric ophthalmology practice from 2005 to 2016. The charts of 22 children (44 eyes) with facial port wine stain were reviewed. The data extracted included demographics, results of ophthalmic examination findings and treatment(s). The main outcome measures were the number of eyes stratified as glaucoma, glaucoma suspects and no glaucoma at the initial and final presentations.

RESULTS

The average age of presentation was 18.2 (±33.9) months. After a follow-up of over 16.1 (±24.8) months, there were 34%, 30% and 36% of the study eyes diagnosed as glaucoma, glaucoma suspects and no glaucoma, respectively with mean ± standard deviation of intraocular pressure of 20.6 ± 5.1, 13.6 ± 5.4 and 7.5 ± 1.7 mmHg. The majority (91%) of eyes presenting with glaucoma had clear corneas. In total, 11 eyes were operated upon for glaucoma. The recorded success rate was 91%. Two eyes developed a postoperative exudative choroidal detachment, of which one resolved spontaneously and the other was successfully managed by intravitreal gas injection.

CONCLUSION

Glaucoma is a significant ocular hazard in children with facial port wine stain that may not be evident on the initial presentation. The presentation is usually with a clear cornea and surgical intervention is associated with a high success rate and a low rate of complications.

Long-term efficacy of endoscopic cyclophotocoagulation in the management of glaucoma following cataract surgery in children

PURPOSE

To report the long-term efficacy of endoscopic cyclophotocoagulation (ECP) in pediatric glaucoma following cataract surgery (GFCS).

METHODS

ECP was performed on 35 eyes of 25 patients <16 years of age with GFCS. Patients were followed for a minimum of 2 years. Treatment failure was defined as consecutive postoperative intraocular pressure (IOP) of >24 mm Hg, alternative glaucoma procedure following ECP, or occurrence of visually significant complications. Analysis was performed to estimate risk factors for failure.

RESULTS

A total of 27 aphakic and 8 pseudophakic eyes were included. Pretreatment IOP averaged 33.9 ± 7.9 mm Hg. Final IOP after a mean follow-up period of 7.2 years was 18.9 ± 8.8 mm Hg (P < 0.001). The success rate was 54% (19/35 eyes). The failure rate was not increased in pseudophakic patients relative to aphakic patients. Patients with single ECP demonstrated preserved visual acuity from baseline to final follow-up.

CONCLUSIONS

In this patient cohort, with average follow-up period of 7.2 years, ECP was useful in the treatment of pediatric GFCS.

Corneal thickness in uveal coloboma with microcornea

PurposeTo evaluate the relationship between central corneal thickness (CCT) and horizontal corneal diameter (HCD) in eyes with uveal coloboma and microcornea.Patients and methodsAll adult patients with uveal coloboma having microcornea in at least one eye and seen between May 2014 and July 2016 at the cataract clinic of our tertiary eye care center were evaluated. The study group comprised 26 colobomatous eyes of 15 patients who had associated microcornea. The control group comprised eyes with uveal coloboma and normal-sized cornea (n=12 eyes of 9 patients). The main outcome measure included the relationship between CCT and HCD in eyes with uveal coloboma and microcornea.ResultsThe mean HCD of the study and control groups was 6.97±1.28 and 11.39±0.67 mm, respectively. The mean central pachymetry of the study group was 668.4±40.2 μm compared with 555.3±41.8 μm in the control group. In both the groups, CCT was negatively correlated with HCD (R=-0.62 in the study group and R=-0.72 in the control group).ConclusionsUveal colobomatous eyes with microcornea have thicker corneas compared with uveal colobomatous eyes with normal diameter corneas that have normal central corneal thickness. In all the eyes with uveal coloboma, there is a negative correlation between horizontal corneal diameter and central corneal thickness.

Clinical management outcomes of childhood glaucoma suspects

Purpose

To investigate the outcomes of childhood glaucoma suspects.

Design

Retrospective case series.

Methods

Records of childhood glaucoma suspects were identified using financial claims data; medical history, baseline biometric and exam findings were recorded. Conversion from suspect to glaucoma was determined based on the Childhood Glaucoma Research Network criteria. The study adheres to the tenets of the Declarations of Helsinki.

Results

214 subjects were enrolled, with median age at initial presentation of 6.37 years (interquartertile range: Q1 = 2.46, Q3 = 8.90). 22 (10.2%) subjects developed glaucoma, 64 (29.9%) had ocular hypertension but no glaucoma, 9 (4.2%) had high-risk condition or syndrome without either ocular hypertension or glaucoma after a mean follow up of 39 +/- 34 months. Neither a family history of glaucoma nor patient gender was significantly different between the groups. 40.2% of subjects (86 of 214) had two or more episodes of intraocular pressure (IOP) > 21 mmHg, among which 25.6% (22 of 86) developed glaucoma after a mean duration of 32.8 +/- 33.5 months.

Conclusions

Up to 25% of children with 2 or more episodes of elevated IOP may develop glaucoma. In 50% of suspects who converted to glaucoma, elevated IOP was not present at the initial evaluation. There is no significant difference in gender, family history, or baseline central corneal thickness between suspects who developed glaucoma compared to the rest. While suspects who converted to glaucoma had higher average, maximum and minimum IOP measurements, there is no clear cutoff between the groups.