ATLANTIC CITY, N.J. — Pediatric glaucoma is a multifactorial disease spectrum that is difficult to diagnose and treat, according to a speaker here.
Lama A. Al-Aswad, MD, presented pearls on diagnosis and management of pediatric glaucoma at the Current Concepts in Ophthalmology meeting.
“Pediatric glaucoma is one of the controversial and difficult glaucomas to deal with for multiple reasons,” Al-Aswad said. “The patient is young. … Their life expectancy is so long, and we’re not sure that their vision can outlive them.”
Pediatric glaucoma is classified as primary and secondary. The primary class is divided into three age subclassifications: newborn to 1 month, 1 month to 2 years, and early childhood to adulthood, Al-Aswad said.
Beta blockers and carbonic anhydrase inhibitors are used initially or after surgery. Prostaglandins work but are less effective than in treating adult glaucoma. Alpha agonists should be avoided, Al-Aswad said.
Goniotomy and trabeculotomy are primary and secondary procedures in pediatric glaucoma. Complications include hyphema, peripheral anterior synechiae and cataract.
Early surgery is optimal; the success rate is 80% to 90% in children ages 3 months to 12 months, 26% in children younger than 1 month and 38% in children older than 2 years.
One study showed that, in the long term, 33% of patients had severe visual impairment and that glaucoma progressed in one-third of patients; the success rate at age 40 years was 48.6%, Al-Aswad said.
Disclosure: Al-Aswad is a consultant/advisor for and has received research grants from Alcon and Allergan.