Treatment Outcomes for Juvenile Open Angle Glaucoma in Thailand.

PRCIS: Juvenile open angle glaucoma (JOAG) patients with thick central corneas and negative family history were more likely to undergo surgery, mainly trabeculectomy with half requiring additional surgery within 10 years. PURPOSE: To assess the characteristics and treatment outcomes of patients with JOAG in Thailand. PATIENTS AND METHODS: This retrospective, multicenter study included all patients diagnosed with JOAG over 12 years from 2 tertiary hospitals in Bangkok, Thailand. RESULTS: A total of 200 eyes from 104 patients were included in this study. The mean age of onset was 24.0±10.1 years (range: 5-40 y), with male predominance (60.5%). Over 90% of patients had bilateral JOAG and 25% had a positive family history. Negative family history (adjusted odds ratio=4.59, P =0.02) and thick central corneal thickness were surgical predictors (every 10 µm adjusted odds ratio=1.29, P =0.01). Over 70% of cases needed glaucoma surgery. Trabeculectomy with Mitomycin-C was performed on 131 eyes (65.5%) with a cumulative probability of complete success of 71.0%, 57.8%, 39.2%, and 26.9% and qualified success of 86.3%, 73.6%, 64.8%, and 45.7% at 1, 3, 5, and 10 years, respectively. The mean follow-up after surgery was 94.9 ± 69.8 months (range: 13-153 mo). There were no serious postoperative complications. Myopia and the number of baseline glaucoma medications were significantly associated with surgical failure. CONCLUSIONS: Trabeculectomy with mitomycin C was the most common primary surgery performed in Thai patients with JOAG, and successfully reduced intraocular pressure without significant complications. Patients with thicker corneas were more likely to undergo surgery. By 10 years, half of the patients required additional surgery and risk factors for failure included myopia and the number of medications.

Two types of childhood glaucoma secondary to familial exudative vitreoretinopathy.

BACKGROUND: Glaucoma secondary to familial exudative vitreoretinopathy presents as angle closure by either neovascular or non-neovascular mechanisms. We analyze the presentation and outcomes of two types of childhood glaucoma secondary to familial exudative vitreoretinopathy (FEVR). METHODS: This retrospective cross-sectional study included all patients <18 years of age diagnosed with glaucoma after or concurrently with a diagnosis of FEVR between 2010 and 2020 from Queen Sirikit National Institute of Child Health in Bangkok, Thailand. Two groups were analyzed: neovascular or non-neovascular angle-closure status. Primary outcome measures were final visual acuity and intraocular pressure (IOP) in both groups. RESULTS: Of 144 FEVR patients, 8 children (5.5%; 11 eyes, 3 bilateral cases) developed childhood glaucoma. Mean time between FEVR presentation and glaucoma was 42.2 ± 40.0 months. In the neovascular group, 3 of 9 eyes presented with glaucoma at FEVR diagnosis; 3 of 9 eyes (33%) required glaucoma surgery. In the non-neovascular group, 2 eyes presented with acute angle closure secondary to a phacomorphic lens. Both were treated with trabeculectomy, with resolution of pupillary block. All eyes had stage 4B FEVR or greater. Six of 8 eyes had stable or better visual acuity, and 10 eyes (91%) had IOP <21 mm Hg at final follow-up. CONCLUSIONS: Childhood glaucoma secondary to FEVR is a rare complication caused by later stages of the disease. It may present as neovascular or non-neovascular angle closure, often requiring complex care. Therefore, awareness and adequate management of FEVR can help prevent additional morbidity from childhood glaucoma.

Effects of digital devices and online learning on computer vision syndrome in students during the COVID-19 era: an online questionnaire study.

PURPOSE: Computer vision syndrome (CVS) describes a group of eye and vision-related problems that result from prolonged digital device use. This study aims to assess the prevalence and associated factors of CVS among students during the lockdown resulting from the COVID-19 pandemic. METHODS: A cross-sectional, online, questionnaire-based study performed among high school students in Thailand. RESULTS: A total of 2476 students, with mean age of 15.52±1.66 years, were included in this study. The mean number of hours of digital device use per day (10.53±2.99) increased during the COVID-19 pandemic compared with before its advent (6.13±2.8). The mean number of hours of online learning was 7.03±2.06 hours per day during the pandemic. CVS was found in 70.1% of students, and its severity correlated with both the number of hours of online learning and the total number of hours of digital device usage (p<0.001). Multiple logistic regression analysis revealed that the factors associated with CVS included age ≤15 years (adjusted OR (AOR)=2.17), overall digital device usage >6 hours per day (AOR=1.91), online learning >5 hours per day (AOR=4.99), multiple digital device usage (AOR=2.15), refractive errors (AOR=2.89), presence of back pain (AOR=2.06) and presence of neck pain (AOR=2.36). CONCLUSIONS: The number of hours of digital device usage increased during lockdown. Over 70% of children had CVS, whose associated factors, including hours of digital device usage, hours of online learning, ergonomics and refractive errors, should be adjusted to decrease the risk of acquiring this condition. Online learning will remain, along with CVS, after this pandemic, and we hope our research will be taken into account in remodelling our education system accordingly.

The effect of repeated measurements and the use of topical anesthetic on rebound tonometry values in children.

Measurement of intraocular pressure (IOP) in children is important in the management of pediatric glaucoma. Availability of the Icare rebound tonometer has greatly facilitated our ability to obtain awake IOP in infants and children, but little has been reported on either the effect of repeated sequential IOP measurements with Icare or the effect of topical anesthetic on subsequent Icare tonometry. This prospective study of 20 eyes of 10 cooperative children (12 normal eyes, 8 with suspected or known glaucoma) found that neither 8 sequential Icare measurements nor application of topical anesthetic produced a statistically or clinically signficant change in measured IOP by rebound tonometry.

Intraocular pressure in children: the effect of body position as assessed by Icare and Tono-Pen tonometers.

PURPOSE: To explore the effect of body position (sitting vs supine) on intraocular pressure (IOP) in children, as assessed by the Icare PRO and the Tono-Pen. DESIGN: Prospective clinical study. METHODS: Children with known or suspected glaucoma and those without glaucoma were recruited from the Duke Eye Center pediatric clinic. Subjects underwent tonometry in both eyes while upright (sitting), after instillation of topical anesthetic, with either the Icare PRO or the Tono-Pen first, and then the second instrument (order randomized). Goldmann applanation tonometry (GAT) was then performed by a clinician masked to the previous measurements. The subjects were then placed in the supine position for 5 minutes, and tonometry using the Icare PRO and the Tono-Pen was obtained, in the same order used when they were the sitting position. RESULTS: Enrolled were 47 children (94 eyes). Mean seated IOP for GAT, Icare PRO and Tono-Pen were 16.4 ± 4.2, 17.5 ± 3.5, and 18.0 ± 3.9 mm Hg, respectively. The mean supine IOP for the Icare PRO and Tono-Pen were 18.4 ± 4.5 and 18.8 ± 4.2 mm Hg, respectively. This rise was +0.9 ± 2.3 mm Hg for Icare PRO (P = 0.01) and +0.7 ± 1.8 mm Hg for Tono-Pen (P = 0.009), respectively. CONCLUSION: In children, Icare PRO tonometry correlates well with GAT in the sitting position, and with the Tono-Pen in both the sitting and supine positions. IOP rises when a child changes position from sitting to supine when measured by the Icare PRO or the Tono-Pen. However, the increase, which is less than 1 mm Hg, seems clinically insignificant and is unlikely to alter glaucoma management in children.

Second glaucoma drainage devices in refractory pediatric glaucoma: failure by fibrovascular ingrowth.

PURPOSE: To evaluate initial glaucoma drainage device failure and subsequent glaucoma drainage device placement for refractory pediatric glaucoma. DESIGN: Retrospective interventional case series. METHODS: The Duke University surgical records from a single surgeon from 1997 to 2012 were reviewed for patients having at least 2 glaucoma drainage devices for refractory pediatric glaucoma. Data collected included glaucoma diagnosis, age at surgery, surgical interventions, preoperative/postoperative IOP and medications, and complications. Failure was defined as having an IOP >21 mm Hg (or clinically inadequate), and/or IOP-reducing surgery/devastating complication. RESULTS: Forty-three eyes (37 patients) had 2 or more glaucoma drainage devices. Mean age at second glaucoma drainage device implantation was 9.2 ± 7.1 years, with mean IOP 30 ± 11 mm Hg, on 3 ± 1 IOP-lowering medications. Fibrovascular ingrowth was documented during second glaucoma drainage device surgery in 12 of 43 eyes (28%), occurring only in Ahmed devices, at a mean of 70 months (range 11-153) after initial implantation. Failure of the second glaucoma drainage device surgery occurred in 18 of 43 eyes (42%) at mean 26.1 ± 32.2 months (median 19.3 months). Surgical success of second glaucoma drainage devices (Kaplan-Meier analysis) at 1 year, 2 years, and 3 years was 81%, 62%, and 50%, respectively. CONCLUSIONS: Single glaucoma drainage device surgery fails to control IOP in some eyes with refractory pediatric glaucoma. Second glaucoma drainage device implantation offers a treatment option with modest success over time. Fibrovascular ingrowth should be suspected as a relatively common cause of IOP elevation and failure after Ahmed device implantation.

Anterior segment photography in pediatric eyes using the Lytro light field handheld noncontact camera.

PURPOSE: To compare anterior segment findings identified in young children using digital photographic images from the Lytro light field camera to those observed clinically. METHODS: This was a prospective study of children <9 years of age with an anterior segment abnormality. Clinically observed anterior segment examination findings for each child were recorded and several digital images of the anterior segment of each eye captured with the Lytro camera. The images were later reviewed by a masked examiner. Sensitivity of abnormal examination findings on Lytro imaging was calculated and compared to the clinical examination as the gold standard. RESULTS: A total of 157 eyes of 80 children (mean age, 4.4 years; range, 0.1-8.9) were included. Clinical examination revealed 206 anterior segment abnormalities altogether: lids/lashes (n = 21 eyes), conjunctiva/sclera (n = 28 eyes), cornea (n = 71 eyes), anterior chamber (n = 14 eyes), iris (n = 43 eyes), and lens (n = 29 eyes). Review of Lytro photographs of eyes with clinically diagnosed anterior segment abnormality correctly identified 133 of 206 (65%) of all abnormalities. Additionally, 185 abnormalities in 50 children were documented at examination under anesthesia. CONCLUSIONS: The Lytro camera was able to document most abnormal anterior segment findings in un-sedated young children. Its unique ability to allow focus change after image capture is a significant improvement on prior technology.