Early findings can predict long-term IOP control and visual acuity outcomes in primary and secondary childhood glaucoma and provide the data for a severity staging system, according to a study.
A group of researchers at the Bascom Palmer Eye Institute investigated the clinical factors potentially associated with poor long-term outcomes in a cohort of 15 children younger than 3 years who presented to the institute over 20 years, from 1990 top 2010. Data were collected at the initial visit, the following two visits, at 3 and 5 years, and at the most recent visit.
Three variables at the third visit, 7 months on average after presentation, already showed significant association with final LogMAR visual acuity, approximately 11 years later. They were anterior segment dysgenesis, nystagmus and previous failed angle surgery. Two additional variables showed significance at the 3-year visit, namely, failed amblyopia therapy and media opacity.
Worse final IOP control was significantly associated with the presence of media opacities and with failed angle surgery at 3 years.
The authors noted that a history of failed angle surgery may be an indirect marker for abnormality of the outflow apparatus beyond the trabecular meshwork. On the other hand, the association between media opacity and worse final IOP control suggests either a more severe disease phenotype, with extensive corneal damage, or the negative effect of surgical procedures such as cataract extraction or corneal transplantation on the long-term efficacy of glaucoma surgeries.
“In our effort to establish a severity staging system for childhood glaucoma, we will collaborate with international tertiary childhood glaucoma centers and modify our analysis for a better modeling of early risk factors,” the authors concluded. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.