Epidemiology and long-term outcomes of primary congenital glaucoma: a population-based study.

BACKGROUND/OBJECTIVES: to establish the incidence, prevalence and long-term outcomes of primary congenital glaucoma (PCG) in Northern Ireland's general and Irish Traveller (IT) populations over a 59-year period. SUBJECTS/METHODS: chart review of all PCG cases in Northern Ireland between 1962 and 2020. Incidence and prevalence were calculated with the aid of national population statistics. Long-term outcomes were analysed for eyes with at least 5 years follow up. Visual outcomes were stratified into groups: good-VA ≥ 6/12; moderate-VA 6/12 to 6/60, poor-VA < 6/60. Kaplan-Meier analysis was constructed to determine the probability of eyes retaining a good visual outcome over time. Outcomes of different surgeries were compared with regard to final vision, re-operations and complications. RESULTS: 57 PCG cases were identified between 1962 and 2020. Overall incidence was 3.4 per 100,000 live births. PCG prevalence in general and IT populations in 2019 was 4.3 per 100,000 and 238 per 100,000, respectively. Sixty eyes had sufficient data for long-term outcome analysis with a mean of 20.5 years follow up, 58% of which had good final visual outcome. Fifty-seven percent of eyes required multiple surgeries. Visual outcomes between trabeculectomies and tubes were comparable; however, there were more serious complications and reoperations associated with tubes. CONCLUSIONS: Incidence of PCG in NI is similar to Great-Britain and Ireland; however, PCG appears to be particularly prevalent within IT community. Although a good visual outcome can be achieved in the majority of patients, a subset of cases remain challenging to manage despite surgical advances.

Microvascular diabetic complications are more prevalent in India compared to Mauritius and the UK due to poorer diabetic control.

Type 2 diabetes mellitus (T2DM) is a growing worldwide problem with WHO estimates suggesting that 300 million people will be affected by 2025. T2DM could result in both microvascular and macrovascular complications but the presentation of these complications could vary globally and be influenced by diabetic control. We investigated the prevalence of these complications by surveying 787 patients of south-Asian origin in diabetic clinics in the UK (n=351), Mauritius (n=173) and India (n=263). We found the prevalence of microvascular complications such as retinopathy (India 16.3%; Mauritius 2.3%; UK 2.6%), nephropathy (India 20.5%; Mauritius 10.5%; UK 2.3%) and neuropathy (India 8.4%; Mauritius 1.2%; UK 5.1%) complications to be significantly higher in India compared to Mauritius and the UK (p<0.05). Interestingly, macrovascular complications such as cardiovascular disease were significantly more prevalent in Mauritius and the UK compared to India (p<0.05). The use of diabetic medication such as Metformin, Sulphonylureas and Insulin was significantly higher in the UK and Mauritius compared to India (p<0.05). The mean HbA1c was significantly higher in India compared to the UK (India 8.68%; UK 8.30%). Our results suggest that microvascular complications are higher in India due to poorer diabetic control. Our findings could be explained by late-onset presentation of diabetic patients in India due to the lack of primary care initiatives to screen and monitor treatment of T2DM. Furthermore, the poor diabetic control in India could reflect a dearth of clinical, evidence-based-knowledge regarding diabetic medication amongst Indian physicians. In view of the global increase in T2DM, this is a major concern for Indian healthcare.