背景:儿童青光眼是全球儿童失明的主要原因。在撒哈拉以南非洲,儿童青光眼的特征尚未得到很好的表征。因此,这项研究旨在描述人口统计学,临床特征,儿童青光眼的管理,以及从基线到最终就诊的视力(VA)和眼内压(IOP)的改善。
方法:这项回顾性研究包括2019年9月至2022年8月诊断的18岁以下青光眼患者。根据儿童青光眼研究网络分类(CGRN)进行儿童青光眼诊断和分类。
结果:共有105名儿童(181只眼)被诊断为青光眼。儿童青光眼最常见的类型是原发性先天性青光眼(PCG)构成(42%,n=76只眼睛,95%置信区间(CI),34.7-49.5%;P=0.037),其次是青光眼嫌疑人(22.1%,n=40只眼睛,95%CI,16.3-28.9%;P<0.001)和青少年开角型青光眼(JOAG)(15.5%,n=28只眼睛,95%CI,10.5-21.6%;P<0.001)。虽然继发性青光眼最常见的类型是类固醇诱导的青光眼,其次是白内障手术后的青光眼。在72.4%的儿童中发现了双侧青光眼(n=76,儿童的95%CI,62.8-80.7%;P<0.001)。在原发性和继发性青光眼中,男孩比女孩受影响更大,比例分别为2:1和2.7:1。PCG患者的平均年龄为2.7岁。接近93.4%(71)的PCG眼通过手术治疗,其中大多数接受了联合小梁切开术和小梁切除术(CTT)。大多数继发性青光眼病例均采用药物治疗。总的来说,85.3%(111)眼成功控制IOP≤21mmHg。
结论:PCG是儿童青光眼最常见的类型。发展中国家公认的挑战之一,PCG患者的晚期表现,在我们的研究中也观察到了。其中突出显示,需要增加获得眼部护理服务的机会,并将儿童青光眼作为主要的公共卫生问题。类固醇性青光眼是继发性青光眼最常见的类型;应采取适当措施预防这种可预防的青光眼。
BACKGROUND: Childhood glaucoma is a major cause of childhood blindness worldwide. The profile of childhood glaucoma has not been well characterized in sub-Saharan Africa. Thus, this
study was designed to describe demographics, clinical features, managements of childhood glaucoma, and improvements in visual acuity (VA) and intraocular pressure (IOP) from baseline to final visit.
METHODS: This retrospective
study included glaucoma patients below 18 years old who were diagnosed between September 2019 to August 2022. Childhood glaucoma diagnosis and classification was made as per the Childhood Glaucoma Research Network Classification (CGRN).
RESULTS: A total of 105 children (181 eyes) were diagnosed with glaucoma. The most common type of childhood glaucoma was primary congenital glaucoma (PCG) constituting (42%, n = 76 eyes, 95% confidence interval (CI), 34.7-49.5%; P = 0.037), followed by glaucoma suspect (22.1%, n = 40 eyes, 95% CI, 16.3-28.9%; P < 0.001) and juvenile open-angle glaucoma (JOAG) (15.5%, n = 28 eyes, 95% CI, 10.5-21.6%; P < 0.001). While the most common type of secondary glaucoma was steroid-induced glaucoma, followed by glaucoma following cataract surgery. Bilateral glaucoma was found in 72.4% (n = 76 children, 95% CI, 62.8-80.7%; P < 0.001) of children. In both primary and secondary glaucoma, boys were affected more than girls, in ratio of 2:1 and 2.7:1, respectively. The mean age at presentation for patients with PCG was 2.7 years. Close to 93.4% (71) of PCG eyes were managed surgically, of which majority underwent combined trabeculotomy and trabeculectomy (CTT). Most of secondary glaucoma cases were treated medically. Overall, 85.3% (111) of eyes had successful control of IOP ≤ 21 mmHg.
CONCLUSIONS: PCG was the most common type of childhood glaucoma. One of a well-recognized challenge in developing countries, late presentation of patients with PCG, was also observed in our
study. Which highlights, the need of increasing access to eye-care service and awareness of childhood glaucoma as a major public health issue. Steroid-induced glaucoma was the most common type of secondary glaucoma; appropriate measures should be taken to prevent this preventable glaucoma.