Risk Factors for Glaucoma Drainage Device Exposure in Children: A Case-Control Study.

PURPOSE: To identify the risk factors for glaucoma drainage device (GDD) exposure in children. DESIGN: Retrospective case-control study. METHODS: The study population comprised children (one eye each) who presented with a history of GDD exposure to a tertiary care eye hospital over the period January 2014 to January 2020. Consecutive children (age <18 years) were included. A control group from the same time period (children without GDD exposure) were included in the ratio of 5 controls to every 1 case of exposure. The main outcome measures included risk factors for exposure (univariate and multivariate analysis). RESULTS: A total of 21 eyes (of 21 children with implant exposure) and 115 eyes (of 115 children without exposure) were included in this study. During the same study period, a total of 494 eyes had undergone GDD implantation, giving an estimated incidence of exposure of 4.25%). In the bivariate analysis, GDD exposure was associated with multiple previous ocular surgeries (P = .001), longer follow-up duration (P < .001), combined procedure at the time of primary implantation (P = .002), and a younger age at the time of primary implantation (P = .006). The former 3 risk factors continued to prove a statistically significant association on multivariable regression analysis. Postoperative use of eye lubricants was more common among children in the control group (P = .007). CONCLUSION: In pediatric glaucoma patients, younger age and combined procedure at the time of primary GDD implantation, in addition to multiple previous ocular surgeries, were associated with greater risk of implant exposure. Postoperative use of eye lubricants may be protective.

Risk Factors for Blindness in Children With Primary Congenital Glaucoma-Follow-up of a Registry Cohort.

PURPOSE: To evaluate the baseline features associated with blindness in a cohort of children with primary congenital glaucoma (PCG) from a hospital registry. DESIGN: Retrospective clinical cohort study. METHODS: Setting: Observational cohort study. StudyPopulation: The registry included all children who presented to our tertiary care institute between 1995 and 2014 with a diagnosis of childhood glaucoma. ObservationProcedure: Baseline characteristics at initial presentation of children with PCG in the registry who were blind at the last follow-up were compared with those who were not blind, using bivariate and then multivariate regressions to account for potential confounders. MainOutcomeMeasures: Blindness was defined as a best-corrected visual acuity of 3/60 (20/400) or worse in the better eye at the final follow-up. RESULTS: The eligible sample consisted of 196 children with a mean age of 9.54 ± 22.44 months at presentation. After a mean ± standard deviation follow-up of 8.49 ± 3.85 years, 20 (10.2%) children were blind. The baseline demographic factors, intraocular pressure, horizontal corneal diameter, spherical equivalent, axial length, and corneal thickness, were similar for the "blind" and "not blind" groups (P > .05). In the multivariate regression, only the severity of corneal opacification remained significantly (P < .001) associated with the risk of blindness (odds ratio = 4.05; 95% confidence interval: 1.89-8.85). CONCLUSION: Corneal clouding is a predictor of future blindness in children with PCG. Children with severe corneal clouding may need more aggressive intraocular pressure control, closer follow-up, and earlier counseling.

Risk Factors for Glaucoma Drainage Device Exposure in a Middle-Eastern Population.

PRéCIS:: In this case-control study, female sex, and older age were risk factors for tube exposure; risk was related to the number of prior ocular surgeries and scleral patch graft (compared with pericardial graft) was found to protect against exposure. PURPOSE: Identification of potential risk factors for glaucoma drainage device (GDD) exposure may help to prevent this potentially blinding complication. The purpose of this study was to evaluate the possible risk factors for GDD exposure in a tertiary eye care center in the Middle-East. METHODS: A retrospective case-control study was undertaken for a 7-year period (2008 to 2015 inclusive). All patients who presented with a GDD incident exposure were identified and were compared with a similar number of controls (without exposure) identified during the same period. Demographic factors, past ocular history, treatment, and surgical technique were recorded for both groups. Bivariate and multivariable analyses were used to identify possible risk factors for tube exposure. RESULTS: A total of 836 patients underwent GDD surgery during this time period and 53 patients were identified with exposure, giving a cumulative incident exposure rate of 6.3% (0.9% per year). Bivariate analysis showed that the median age of cases (51 years) was similar to controls (53 years) (P=0.95), while there was a greater proportion of women with exposure (49%) compared with the control group (28%) with a statistically significant difference (P=0.028). The number of previous surgeries (3.77±2.1) was significantly higher (P=0.018) in the exposure group (4.25±2.0) compared with controls (3.3±2.0). With each unit increase in the number of previous surgeries, the odds of exposure significantly increased by 1.29 (95% confidence interval, 1.05-1.57). In the multivariable regression, female sex (P=0.006) and older age (P=0.025) were significant risk factors and use of a scleral patch (P=0.02) graft potentially protective. CONCLUSIONS: Previous surgery, female sex, and older age are potential risk factors identified in our study. The use of scleral patch graft is potentially protective against GDD extrusion. Further study is needed to elucidate the reasons for these causative and protective factors.

Screening for cardiovascular risk in asymptomatic users of the primary health care network in Lebanon, 2012-2013.

INTRODUCTION: In 2012, the Ministry of Public Health in Lebanon piloted a service of multifactorial cardiovascular screening in the publicly subsidized Primary Health Care (PHC) Network. We present an epidemiological analysis of data produced during this pilot to justify the inclusion of this service in the package of essential services offered through PHC and to present a preliminary cardiovascular risk profile in an asymptomatic population. METHODS: A total of 4,205 participants (two-thirds of which were women) aged at least 40 years and reportedly free from diabetes, hypertension, dyslipidemia, and cardiovascular disease (CVD) were screened. The screening protocol used a questionnaire and direct measurements to assess 5 modifiable cardiovascular risk factors; total cardiovascular risk score was calculated according to a paper-based algorithm developed by the World Health Organization and the International Society of Hypertension. RESULTS: Approximately 25% of the sample displayed metabolic impairments (11% for impaired blood glucose metabolism and 17% for impaired systolic blood pressure), and 6.6% were classified at total cardiovascular risk of 10% or more. Just over one-quarter of the sample was obese, almost half had a substantially elevated waist circumference, and 41% were smokers. Men were significantly more likely to screen positive for metabolic impairment than women, and women were more likely to be obese. CONCLUSION: The implementation of a multifactorial screening for CVD among asymptomatic subjects detected a substantial proportion of previously undiagnosed cases of high metabolic risk, people who could now be referred to optimal medical follow-up.