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William Eric Sponsel, Kristen Crosnoe; Pediatric Eversional Angle Closure with Headache; A Very Treatable Progressive Glaucoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4989.
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We have encountered a large set of juvenile patients who present with three consistent findings: 1) recurrent accommodation- and light-induced frontal headache, 2) distinctive gonioscopic findings (profound distensibility of the iris on goniocompression and concentric linear iris pigment tidemark anterior to the trabecular meshwork), and 3) generalized depression of light sensitivity on Frequency Doubling Technology (FDT) perimetry. We call this syndrome “pediatric eversional angle closure with headache” (PEACH). This study objectively assesses the alteration in symptoms and visual field performance in such pediatric patients after 2-step argon/YAG laser peripheral iridotomy (LPI) for this newly identified form of intermittent angle closure glaucoma.
Case control clinical review of subjects <18 years with PEACH undergoing LPI from 2010-2015 with pre- and post-laser FDTs. Resolution of frontal headache, change in mean deviation on FDT were assessed at baseline and the closest assessment to 1 year post-laser (9-15 mo). An age-associated control group of non-PEACH pediatric glaucoma patients on other therapy was assessed to adjust for any potential learning effect in FDT findings. Student t-test analyzed the comparative results. Ultrabiomicroscopic (UBM) imaging was performed before and after inducing characteristic frontal headache in one subject who had previously undergone LPI in one eye only.
38 eyes (20 patients; range 7-15 years) qualified for laser treatment with all 3 clinical syndrome features confirmed. All 20 patients had total resolution of their longstanding recurrent frontal headaches. Their pre-laser FDT mean MD was -7.5±0.8 dB, and post-laser -3.4±0.5 (p<0.0001). Control group eyes (22; range 7-14 years) yielded mean baseline MD -6.7±0.9 dB and follow-up -5.5±0.8 (p<0.05). The difference between groups was substantial and highly significant (+3.0dB; p=0.003; Figure 1). Figure 2 shows UBM images of the untreated eye of a teenage male before and after 10 min reading his iPhone to induce IOP elevation and frontal headache over that eye. His previously worse-afflicted fellow eye pupil constricted, but its previously treated iris remained planar with open angle, normal IOP, and no ipsilateral headache.
Pediatric patients with frontal headache and verified visual field compromise should be evaluated for PEACH, a condition with high prospects for therapeutic benefit.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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