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Katie W. Goldhair, Tyler Kirk, Omolola Idowu; Childhood Glaucomas in Mississippi 2005-2010: A Retrospective Review of Diagnoses, Treatment, and Outcomes. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4473.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the different mechanisms of pediatric glaucoma and treatment outcomes in the pediatric population of Mississippi.
A retrospective chart review was done on pediatric glaucoma patients in Mississippi who presented to UMMC and treated from 2005-2010. Childhood glaucoma patients were identified from the pediatric clinic and glaucoma clinic based on ICD9 codes from 2005-2010. Diagnosis, medical and surgical treatments, complications, IOPs, visual acuity, cup-to-disc ratio, and associated ocular and systemic pathologies were analyzed. The main outcome measure was IOP control and Snellen VA was recorded when available. Statistical significance of intraocular pressure change by t-test was defined as p<0.05. The inclusion criteria consisted of all patients under 18 with a primary or secondary glaucoma diagnosis treated at Univeristy of Mississippi Medical Center. Exclusion criteria consisted of all glaucoma patients over the age of 18. Sixty patients and 89 eyes were included in this study.
The results included 40 aphakic glaucoma eyes, 33 congenital glaucoma eyes, 2 sturge-weber eyes, 3 neurofibromatosis type 1 eyes, 4 traumatic glaucoma eyes, 3 uveitic eyes, 6 axenfeld- reiger eyes, 4 aniridia eyes, 4 JOAG eyes. The most common etiologies were Primary Congenital Glaucoma and aphakic glaucoma. Treatment included 3 ahmed tube shunts (which were all definitive treatments), 22 trabeculectomies (15 of which were definitive and 4 of which had to be revised), 20 goniotomies/trabeculotomies (7 of which were definitive treatment with 0 revisions), 6 transscleral cyclophotocoagulation treatments which were all definitive, and 2 enucleations. Mean pretreatment IOP was 33.2 and post treatment IOP was 14.1 in all eyes. Mean IOP prior to trabeculectomy was 34 and 13.7 after surgery.
Our study reported a diversity of etiologies leading to childhood glaucoma diagnoses in Mississippi. The most frequently occurring etiologies were Primary Congenital Glaucoma and aphakic glaucoma. Our study suggests a relatively lower incidence of PCG and higher aphakic glaucoma incidence among African Americans. Our study is consistent with the longstanding strategy of goniotomy and trabeculotomy as first line surgical treatment in congenital glaucoma. Our data supports Trabeculotomy/Trabeculectomy+MMC as the most effective means of achieving IOP control in PCG.
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