Clinical Classification of Childhood Glaucomas

Abstract

An updated classification of the primary and secondary childhood glaucomas is offered for clinical use, and associated systemic diseases are included to enable their early recognition in children with known glaucoma.Methods: Approximately 650 clinical records of patients with pediatric glaucoma were reviewed for type of glaucoma and associated systemic disease. A literature search was done for additional reported causes of childhood glaucoma. Previous classifications of pediatric glaucomas were also reviewed. Pertinent references to support inclusion of each clinical entity in the updated classification are included.Results: A comprehensive and referenced classification of the pediatric glaucomas was enabled by this review. Conclusion:A comprehensive, etiologically based classification of the pediatric glaucomas is now available to assist with the recognition of the many causes of primary and secondary glaucoma in childhood and to support the selection of specific treatment choices.

Visual acuity outcomes in pediatric glaucomas

“…[1][2][3] Recent classification schemes of childhood glaucomas have focused on distinguishing the various pediatric glaucomas by etiology, thereby assisting in the selection of treatment choices specific to the given condition. 4 For instance, primary congenital glaucoma often is treated with anterior segment angle surgery such as goniotomy or trabeculotomy as the first-line management strategy, whereas secondary glaucomas, such as those associated with anterior segment dysgenesis and aphakic glaucoma, may be initially managed medically. A better understanding of how the visual prognosis compares between the various pediatric glaucoma subtypes would aid not only in counseling parents at the time of diagnosis but also in tailoring treatment plans to address better an individual patient's greatest risk factor for vision impairment.…”

Pediatric glaucoma terminology

“…Pediatric glaucoma can be categorized based on the etiology, age of onset of the condition, and associated ocular and systemic findings, as primary glaucoma, glaucoma with associated syndromes, and secondary glaucoma [Ho and Walton, ; Yeung and Walton, ]. Advances in the past decade have allowed an enriched understanding of the molecular genetics of glaucoma resulting in new terminology.…”

“…There are a wide variety of syndromes with which glaucoma may occur, usually through goniodysgenesis (Table ) [Yeung and Walton, ]. Other factors may also be involved.…”

Conditions that can be Mistaken as Early Childhood Glaucoma

“…5 While primary congenital glaucoma and developmental glaucoma are the most common forms of pediatric glaucoma, numerous other types exist. 6 When glaucoma occurs within the first few years of life, affected children develop classic phenotypic signs such as increased measured IOP, globe enlargement (buphthalmos) with associated myopia, Descemet membrane tears (Haab striae), corneal edema/scarring with associated astigmatism, iris atrophy, and optic nerve cupping. 1 In addition, symptoms such as photophobia and increased tearing are common.…”