Allen D. Beck
WASHINGTON — The difficulty of obtaining a correct IOP reading, the risks involved with anesthesia and the challenges of classifying pediatric glaucoma can make the treatment course for a pediatric patient complicated, according to a speaker here.
Simply determining a diagnosis of glaucoma in pediatric patients is difficult. Obtaining accurate IOP readings in young patients is a difficult task and may only be possible when a patient is feeding or sleeping, Allen D. Beck, MD, said at the American Glaucoma Society annual meeting.
“The No. 1 thing what you want to do heading towards surgery is to make sure you actually have your diagnosis. I know this sounds silly, but in kids it’s very hard to get pressure readings,” Beck said.
Examinations under anesthesia may be necessary to confirm a diagnosis, but IOP can decrease when pediatric patients are under anesthesia, and other long- and short-term risk factors should be considered. Rebound tonometry is an option to determine IOP in some patients and could lower the need for anesthesia, Beck said.
Classifying patients with primary childhood glaucoma or secondary childhood glaucoma based on international classifications can help determine a course of treatment. Medical therapy is usually the first-line treatment for pediatric glaucoma, Beck said.
“We do go to surgery on a number of them, but the approach may be different. Primary congenital glaucoma responds usually quite well to surgery,” he said.
However, there are concerns about potential long-term neurodevelopmental adverse effects from early exposure to anesthesia. Pediatric anesthesiology is a key part of the algorithm to treat pediatric glaucoma, especially in very young patients, premature children and those with systemic medical issues.
“Surgery and [exams under anesthesia] are a critical part of what we do for these very young children, but we still need to think about each procedure and exam in the context of what is going on with that child and carefully adopt it,” he said.
Short-term anesthesia risks, such as asthma, cardiac issues or other systemic medical issues, may be more concerning than long-term risks, he said. – by Robert Linnehan
Beck AD. Preoperative considerations for pediatric glaucoma surgery. Presented at: American Glaucoma Society annual meeting; Feb. 27-March 1, 2020; Washington.
Disclosure: Beck reports he receives grant support from Allergan.