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Sharon F Freedman - One of the best experts on this subject based on the ideXlab platform.

  • overhead mounted optical coherence tomography in Childhood Glaucoma evaluation
    Journal of Glaucoma, 2020
    Co-Authors: Jill C Rotruck, Navajyoti R Barman, Michael P Kelly, Robert J House, Mays A Eldairi, Sharon F Freedman
    Abstract:

    PReCIS:: Overhead mounted spectral-domain optical coherence tomography (OCT) enables high-quality imaging of the optic nerve and macula in Childhood Glaucoma, and is particularly useful when standard tabletop OCT has failed or is not possible. Purpose Tabletop OCT, integral to adult Glaucoma management, can be limited in Childhood Glaucoma patients because of young age, poor cooperation, and/or technical challenges. To address these imaging difficulties, we determined the feasibility and quality of an overhead mounted unit in Childhood Glaucoma. Secondary aims included evaluation of peripapillary retinal nerve fiber layer (pRNFL), parafoveal total retinal thickness, and parafoveal ganglion cell complex (GCC) thickness. Materials and methods Children and adults with a diagnosis of Childhood Glaucoma were imaged with an overhead mounted spectral-domain OCT as part of a prospective cross-sectional study. Participants had poor quality or unobtainable tabletop OCT and were scheduled for an examination under anesthesia and/or surgery as part of standard care. Results A total of 88 affected eyes in 60 of 65 (92.3%) enrolled patients (mean age, 5.9±5.9 y; range, 0.2 to 24.5) were successfully imaged. The mean image quality for analyzed scans was 22.9±6.0 dB (n=236 images). Mean values for pRNFL (80.5±31.0 µm; n=86), parafoveal total retinal thickness (301.10±39.9 µm; n=79), and parafoveal GCC thickness (96.0±21.6 µm; n=74) were calculated. Conclusions Overhead mounted OCT allowed high-quality image acquisition and analysis in Childhood Glaucoma patients unable to be imaged with the tabletop counterpart, presenting an opportunity for improved clinical management and study of Childhood Glaucoma-related pathophysiology. pRNFL, parafoveal total retinal thickness, and parafoveal GCC thickness were decreased for affected eyes of children under 6 years of age compared with age-matched controls from a companion normative study.

  • the shrinking eye dimensional changes in the young child s eye after Glaucoma drainage device implantation for refractory Childhood Glaucoma
    Journal of Aapos, 2020
    Co-Authors: Ann Shue, Sharon F Freedman
    Abstract:

    Purpose To investigate the magnitude of reduction in the axial length (AL) and corneal diameter following Glaucoma drainage device (GDD) placement and intraocular pressure (IOP) reduction in Glaucoma patients Method The medical records of consecutive Childhood Glaucoma patients who underwent GDD implantation at a single practice between 2013 and 2018 and were Results A total of 16 eyes of 10 patients were included. Before GDD placement, mean AL was 23.49 ± 3.05 mm. Mean AL reduction after placement was 0.80 ± 0.85 mm (P = 0.001); median AL reduction, 0.93 mm (range, −3.05 to +0.59). Mean IOP reduction after GDD placement was 15.0 ± 6.0 mm Hg (P  Conclusions In this study cohort, reduction in AL, corneal diameter, and cup:disk ratio was found to be correlated with reduced IOP after GDD placement. This result merits consideration during surgical planning for Glaucoma patients

  • home tonometry assists Glaucoma drainage device management in Childhood Glaucoma
    Journal of Glaucoma, 2019
    Co-Authors: Navajyoti R Barman, Robert J House, Sharon F Freedman
    Abstract:

    PReCIS:: Home tonometry is useful in detecting tube-opening and alarming intraocular pressures (IOPs) after Baerveldt Glaucoma drainage device (GDD) implantation in Childhood Glaucoma, allowing for timely physician response and individualized patient care. PURPOSE The postoperative management of the nonvalved Baerveldt GDD presents challenges in pediatric patients due to widely variable IOP often occurring perioperatively. We evaluated the use of home tonometry in the management of Baerveldt implants for refractory Childhood Glaucoma. MATERIALS AND METHODS As part of an ongoing prospective study involving home rebound tonometry, the families of patients receiving Baerveldt implants were trained to use the Icare TA01i rebound tonometer and asked to document IOP, relevant symptoms, and ocular medication changes outside of the clinic setting. Data were analyzed for time to tube-opening, multiple-day fluctuations, and various IOP trends. Clinician response to IOP fluctuations detected by home tonometry was also evaluated. RESULTS Included were 19 patients (mean age: 16.1±9.6 y) having Baerveldt implantation from 2015 to 2018 by 1 attending physician. Home tonometry detected 92.3% (12/13) of spontaneous tube-openings, which occurred at a mean of 6.0±0.5 weeks. By home tonometry, mean IOP decreased 32.7% (24 vs. 15 mm Hg, P<0.01); 5-day IOP fluctuation decreased from 15 mm Hg preoperatively to 8 mm Hg after tube-opening (P<0.05). Preoperative, postimplantation, and post-tube-opening IOP ranged from 10 to 59, 3 to 61, and 1 to 51 mm Hg, respectively. Home tonometry prompted 94 documented medication changes and validated 1 surgical decision among 14 patients. CONCLUSIONS Home rebound tonometry accurately detected tube-opening and alarming IOP fluctuations, allowing clinicians to promptly and appropriately respond to these events. Home tonometry-augmented GDD management in Childhood Glaucoma may improve the care of these challenging patients.

  • risk factors for strabismus following Glaucoma drainage device implantation for refractory Childhood Glaucoma
    Journal of Aapos, 2019
    Co-Authors: Sonali D Talsania, Nambi Nallasamy, Andrew R Lee, Sharon F Freedman
    Abstract:

    Background Strabismus is common in children after Glaucoma drainage device (GDD) implantation, but the risk factors for postoperative strabismus remain speculative. The purpose of this study was to investigate possible risk factors for strabismus following GDD implantation for refractory Childhood Glaucoma. Methods The medical records of consecutive patients who underwent GDD implantation for refractory Childhood Glaucoma at Duke Eye Center from 2005 to 2016 were reviewed retrospectively. Pre- and postoperative motility and alignment, best-corrected visual acuity, and demographic and surgical data were extracted from the record for analysis. Results A total of 81 patients (mean age, 7.9 ± 4.8 years) met inclusion criteria. The most common Glaucoma type was Glaucoma following cataract surgery (GFCS), and the most common GDD was a Baerveldt 250 mm2 device. Before GDD surgery, 38 patients (47%) had documented strabismus. After GDD implantation, 25 (31%) had new or worsened strabismus, with vertical (16% of new/worsened), horizontal strabismus (exotropia, 48% of new/worsened; esotropia, 12% of new/worsened) and vertical and horizontal (24% of new/worsened) noted. New motility limitation occurred in 32 of 81 (40%) patients. Risk factors including age, type/location/number of GDD, revision, motility limitation, Glaucoma type, asymmetric visual acuity, and visual impairment were not significantly associated with new or worsened post-GDD strabismus. Conclusions Children with refractory Childhood Glaucoma are at high risk for strabismus, which increases after GDD implantation; this study identified no clear risk factors for new or worsened post-GDD strabismus.

  • endoscopic cyclophotocoagulation ecp for Childhood Glaucoma a large single center cohort experience
    Journal of Aapos, 2019
    Co-Authors: Tanya S Glaser, Michael S Mulvihill, Sharon F Freedman
    Abstract:

    Purpose To assess the factors associated with successful outcomes in the management of Childhood Glaucoma treated with endoscopic cyclophotocoagulation (ECP) as both primary and adjunctive surgery. Methods The medical records of consecutive children with Glaucoma treated by a single surgeon at a single center over a 17-year period using ECP procedures were reviewed retrospectively. Treatment failure was defined as (1) intraocular pressure (IOP) >24 mm Hg at two consecutive examinations despite maximal medical treatment, (2) any additional Glaucoma surgery, (3) sight-threatening complications, or (4) progression to no light perception visual acuity. Success was defined as the absence of treatment failure. Results A total of 107 ECP procedures on 80 eyes of 70 children were included. Glaucoma diagnoses included: following-cataract-surgery (60%), anterior segment dysgenesis (13%), primary congenital (9%), and other (19%). Most eyes (67 [84%]) had prior Glaucoma surgery, and 73 (91%) were aphakic or pseudophakic at first ECP. Median follow-up was 2.2 years (IQR, 1.1-3.5) after initial ECP; mean number of ECP treatments per eye was 1.3 (range, 1-3). Success for a single ECP treatment at 1, 3, and 5 years (Kaplan-Meier analysis) was 64% (95% CI, 54-76), 36% (26-50), and 16% (7-37), respectively. Cumulative success (≥1 ECP) at 5 years was 34% (23-50). In multivariable analysis, of many risk factors considered, only a preoperative IOP of Conclusions ECP represents a modestly effective long-term therapy for Childhood Glaucoma and may be most successful in patients with preoperative IOP of

John Brookes - One of the best experts on this subject based on the ideXlab platform.

  • cyclodiode laser as the first surgical approach in Childhood Glaucoma under the age of 8 years
    Journal of Glaucoma, 2021
    Co-Authors: Petchyim Sakaorat, Jibran Mohamednoriega, Ahmad Sharara, Moritz Claudius Daniel, John Brookes
    Abstract:

    PRCIS Cyclodiode as a primary treatment for Childhood Glaucoma patients younger than 8 years has a 12-month success rate of 55.24%. It can delay the need for penetrating Glaucoma surgery. PURPOSE The purpose of this study was to evaluate the treatment outcome of cyclodiode laser in Childhood Glaucoma for patients under the age of 8 years. DESIGN This was a retrospective, consecutive, noncomparative case series. PARTICIPANTS All Childhood Glaucoma patients who underwent cyclodiode from March 2005 to January 2017 as a primary surgical treatment under the age of 8 years. METHODS A retrospective review of the medical records of consecutive patients who underwent cyclodiode by a single surgeon. MAIN OUTCOME MEASURES Success for single-diode intervention was defined as intraocular pressure (IOP) (>6 wk postoperative) ≤21 mm Hg with antiGlaucoma medications and ≥20% IOP reduction, no further Glaucoma surgery including cyclodiode, no loss of perception of light, and no major complications. Success for multiple-diode interventions was defined similar to the single diode, except that repeated cyclodiode is not considered a failure. RESULTS In all, 59 eyes of 43 patients were studied. The most common diagnosis was aphakic Glaucoma. The mean age at cyclodiode treatment was 2.7 years (SD=2.2). Fifty-six percent of the patients were under 3 years. Success rates at 12 months after the procedure were 46.67% and 55.24% for single-diode and multiple-diode interventions, respectively. An IOP of >20 mm Hg 6 weeks after a cyclodiode session is a significant risk factor for failure with an hazard ratio of 2.41 (95% confidence interval: 1.00-5.81; P=0.05). Among the operated eyes, the surgeon could avoid further Glaucoma surgery in 67.8% of the eyes during the first year after single or multiple cyclodiode sessions. None of the eyes experienced phthisis bulbi, hypotony, and severe uveitis. CONCLUSIONS Cyclodiode laser in Childhood Glaucoma patients under the age of 8 years can be considered a safe alternative for Glaucoma patients who can have a high risk of surgical complications. Performing cyclodiode laser can delay the need for penetrating Glaucoma surgery. The IOP at 6 weeks may be a good predictor for the treatment outcome.

  • Childhood Glaucoma long term outcomes of Glaucoma drainage device implantation within the first 2 years of life
    Journal of Glaucoma, 2019
    Co-Authors: Moritz Claudius Daniel, Jibran Mohamednoriega, Sakaorat Petchyim, John Brookes
    Abstract:

    PReCIS:: Glaucoma drainage device (GDD) implantation within the first 2 years of life yields an overall success rate of 59.0% at 5 years. It is safe and requires a relatively low number of postoperative interventions. PURPOSE The purpose of this study was to evaluate the long-term outcomes of the treatment of Childhood Glaucoma with GDDs within the first 2 years of life. METHODS A total of 43 children (60 eyes) having undergone GDD implantation within the first 2 years of life at Moorfields Eye Hospital between July 2005 and November 2014 were included in this retrospective case series. Kaplan-Meier survival curves were created for the evaluation of surgical success. Log-rank analysis was performed for the detection of risk factors for failure. MAIN OUTCOME MEASURES Overall success rates at 1, 5, and 7 years after surgery. Surgical success: intraocular pressure ≥5/≤21 mm Hg, no further Glaucoma surgery required, nonoccurrence of loss of perception of light or devastating complications. RESULTS The results are listed as follows: Median duration of follow-up was 48.0 months. Median age at surgery was 11.5 months. Seventy-three percentage of children were white. Most common types of Glaucoma were primary congenital Glaucoma [(PCG); 67%], Glaucoma following cataract surgery (18%), and anterior segment dysgenesis (10%). Overall success rates were 93%, 59%, and 59%, respectively. There were no differences in the survival rates as a function of PCG/non-PCG, sex, and removal of intraluminal stent suture. Mean number of general anesthesia administrations during the first postoperative year was 1.8. CONCLUSIONS GDD implantation within the first 2 years of life is effective and safe. The low number of general anesthesia administrations required during the first postoperative year could help to reduce the burden placed on children and carers. Further research is required to directly compare the efficiency of GDD implantation with other surgical options.

Om Siggs - One of the best experts on this subject based on the ideXlab platform.

  • Biallelic CPAMD8 variants are a frequent cause of Childhood and juvenile open-angle Glaucoma
    'Elsevier BV', 2020
    Co-Authors: Om Siggs, Souzeau E, Da Taranath, Dubowsky A, Chappell A, Zhou T, Javadiyan S, Nicholl J, Ls Kearns, Se Staffieri
    Abstract:

    Purpose: Developmental abnormalities of the ocular anterior segment in some cases can lead to ocular hypertension and Glaucoma. CPAMD8 is a gene of unknown function recently associated with ocular anterior segment dysgenesis, myopia, and ectopia lentis. We sought to assess the contribution of biallelic CPAMD8 variants to Childhood and juvenile open-angle Glaucoma. Design: Retrospective, multicenter case series. Participants: A total of 268 probands and their relatives with a diagnosis of Childhood or juvenile open-angle Glaucoma. Methods: Patients underwent a comprehensive ophthalmic assessment, with DNA from patients and their relatives subjected to genome, exome, or capillary sequencing. CPAMD8 RNA expression analysis was performed on tissues dissected from cadaveric human eyes. Main outcome measures: Diagnostic yield within a cohort of Childhood and juvenile open-angle Glaucoma, prevalence and risk of ophthalmic phenotypes, and relative expression of CPAMD8 in the human eye. Results: We identified rare (allele frequency -5) biallelic CPAMD8 variants in 5.7% (5/88) of probands with Childhood Glaucoma and 2.1% (2/96) of probands with juvenile open-angle Glaucoma. When including family members, we identified 11 individuals with biallelic variants in CPAMD8 from 7 unrelated families. Nine of these individuals were diagnosed with Glaucoma (9/11, 81.8%), with a mean age at diagnosis of 9.22±14.89 years, and all individuals with Glaucoma required 1 or more incisional procedures to control high intraocular pressure. Iris abnormalities were observed in 9 of 11 individuals, cataract was observed in 8 of 11 individuals (72.7%), and retinal detachment was observed in 3 of 11 individuals (27.3%). CPAMD8 expression was highest in neural crest-derived tissues of the adult anterior segment, suggesting that CPAMD8 variation may cause malformation or obstruction of key drainage structures. Conclusions: Biallelic CPAMD8 variation was associated with a highly heterogeneous phenotype and in our cohorts was the second most common inherited cause of Childhood Glaucoma after CYP1B1 and juvenile open-angle Glaucoma after MYOC. CPAMD8 sequencing should be considered in the investigation of both Childhood and juvenile open-angle Glaucoma, particularly when associated with iris abnormalities, cataract, or retinal detachment

  • Biallelic CPAMD8 Variants Are a Frequent Cause of Childhood and Juvenile Open-Angle Glaucoma
    'Elsevier BV', 2020
    Co-Authors: Om Siggs, Souzeau E, Da Taranath, Dubowsky A, Chappell A, Zhou T, Javadiyan S, Nicholl J, Ls Kearns, Se Staffieri
    Abstract:

    PURPOSE: Developmental abnormalities of the ocular anterior segment in some cases can lead to ocular hypertension and Glaucoma. CPAMD8 is a gene of unknown function recently associated with ocular anterior segment dysgenesis, myopia, and ectopia lentis. We sought to assess the contribution of biallelic CPAMD8 variants to Childhood and juvenile open-angle Glaucoma. DESIGN: Retrospective, multicenter case series. PARTICIPANTS: A total of 268 probands and their relatives with a diagnosis of Childhood or juvenile open-angle Glaucoma. PURPOSE: Developmental abnormalities of the ocular anterior segment in some cases can lead to ocular hypertension and Glaucoma. CPAMD8 is a gene of unknown function recently associated with ocular anterior segment dysgenesis, myopia, and ectopia lentis. We sought to assess the contribution of biallelic CPAMD8 variants to Childhood and juvenile open-angle Glaucoma. METHODS: Patients underwent a comprehensive ophthalmic assessment, with DNA from patients and their relatives subjected to genome, exome, or capillary sequencing. CPAMD8 RNA expression analysis was performed on tissues dissected from cadaveric human eyes. MAIN OUTCOME MEASURES: Diagnostic yield within a cohort of Childhood and juvenile open-angle Glaucoma, prevalence and risk of ophthalmic phenotypes, and relative expression of CPAMD8 in the human eye. RESULTS: We identified rare (allele frequency < 4×10-5) biallelic CPAMD8 variants in 5.7% (5/88) of probands with Childhood Glaucoma and 2.1% (2/96) of probands with juvenile open-angle Glaucoma. When including family members, we identified 11 individuals with biallelic variants in CPAMD8 from 7 unrelated families. Nine of these individuals were diagnosed with Glaucoma (9/11, 81.8%), with a mean age at diagnosis of 9.22±14.89 years, and all individuals with Glaucoma required 1 or more incisional procedures to control high intraocular pressure. Iris abnormalities were observed in 9 of 11 individuals, cataract was observed in 8 of 11 individuals (72.7%), and retinal detachment was observed in 3 of 11 individuals (27.3%). CPAMD8 expression was highest in neural crest-derived tissues of the adult anterior segment, suggesting that CPAMD8 variation may cause malformation or obstruction of key drainage structures. CONCLUSIONS: Biallelic CPAMD8 variation was associated with a highly heterogeneous phenotype and in our cohorts was the second most common inherited cause of Childhood Glaucoma after CYP1B1 and juvenile open-angle Glaucoma after MYOC. CPAMD8 sequencing should be considered in the investigation of both Childhood and juvenile open-angle Glaucoma, particularly when associated with iris abnormalities, cataract, or retinal detachment

  • Prevalence of FOXC1 variants in individuals with a suspected diagnosis of primary congenital Glaucoma
    'American Medical Association (AMA)', 2019
    Co-Authors: Om Siggs, Souzeau E, Dubowsky A, Pasutto F, Smith Jeh, Taranath D, Pater J, Jl Rait, Narita A, Mauri L
    Abstract:

    Importance: Both primary and secondary forms of Childhood Glaucoma have many distinct causative mechanisms, and in many cases a cause is not immediately clear. The broad phenotypic spectrum of secondary Glaucoma, particularly in individuals with variants in FOXC1 or PITX2 genes associated with Axenfeld-Rieger syndrome, makes it more difficult to diagnose patients with milder phenotypes. These cases are occasionally classified and managed as primary congenital Glaucoma.Objective: To investigate the prevalence of FOXC1 variants in participants with a suspected diagnosis of primary congenital Glaucoma.Design, Setting, and Participants: Australian and Italian cohorts were recruited from January 1, 2007, through March 1, 2016. Australian individuals were recruited through the Australian and New Zealand Registry of Advanced Glaucoma and Italian individuals through the Genetic and Ophthalmology Unit of l'Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda in Milan, Italy. We performed exome sequencing, in combination with Sanger sequencing and multiplex ligation-dependent probe amplification, to detect variants of FOXC1 in individuals with a suspected diagnosis of primary congenital Glaucoma established by their treating specialist. Data analysis was completed from June 2015 to November 2017.Main Outcome and Measures: Identification of single-nucleotide and copy number variants in FOXC1, along with phenotypic characterization of the individuals who carried them.Results: A total of 131 individuals with a suspected diagnosis of primary congenital Glaucoma were included. The mean (SD) age at recruitment in the Australian cohort was 24.3 (18.1) years; 37 of 84 Australian participants (44.0%) were female, and 71 of 84 (84.5%) were of European ancestry. The mean (SD) age at recruitment was 22.5 (18.4) years in the Italian cohort; 21 of 47 Italian participants (44.7%) were female, and 45 of 47 (95.7%) were of European ancestry. We observed rare, predicted deleterious FOXC1 variants in 8 of 131 participants (6.1%), or 8 of 166 participants (4.8%) when including those explained by variants in CYP1B1. On reexamination or reinvestigation, all of these individuals had at least 1 detectable ocular and/or systemic feature associated with Axenfeld-Rieger syndrome.Conclusions and Relevance: These data highlight the genetic and phenotypic heterogeneity of Childhood Glaucoma and support the use of gene panels incorporating FOXC1 as a diagnostic aid, especially because clinical features of Axenfeld-Rieger syndrome can be subtle. Further replication of these results will be needed to support the future use of such panels

Alana L Grajewski - One of the best experts on this subject based on the ideXlab platform.

  • international study of Childhood Glaucoma
    Ophthalmology Glaucoma, 2020
    Co-Authors: Maria Papadopoulos, Elizabeth A Vanner, Alana L Grajewski, Arijit Mithra, Manju R Pillai, Swati Upadhyaya, Ganesh Venkataraman, Ta Chen Peter Chang, Elizabeth Hodapp
    Abstract:

    Purpose To ascertain the types of Childhood Glaucoma managed at major international centers, current clinical practice, and intraocular pressure (IOP) control and visual acuity (VA) outcomes. Design Prospective, multicenter, consecutive case series. Participants All children with newly diagnosed Glaucoma in at least 1 eye who fulfilled the Childhood Glaucoma Research Network (CGRN) definition of Childhood Glaucoma were recruited over a 1-year period with the aim of 18 months follow up. Methods Demographic, clinical, management data (including complications), and outcomes (IOP and VA) were entered in a secure online database. All cases included in the outcome analysis had a minimum of 6 months follow-up. Main Outcome Measures The management of Childhood Glaucoma, IOP control, and VA outcomes. Results A total of 441 children (691 eyes) with newly diagnosed Glaucoma were enrolled from 17 international centers. Approximately 60% of patients came from 2 centers in India; however, 47.5% of Indian patients had no or less than 6 months of follow-up outcome data from diagnosis. Primary congenital Glaucoma (PCG) was the most common diagnosis (45.4%, n = 314 eyes). There was a statistically significant association between diagnosis and ethnicity/race (P Conclusions The most common diagnoses in this international study of children with newly diagnosed Glaucoma in order of frequency were PCG, Glaucoma after congenital idiopathic cataract surgery, and Glaucoma associated with trauma. Indian children had a disproportionately high loss to follow-up rate. Despite international differences in the surgical approach to PCG, there was no statistically significant difference in IOP or VA outcomes. We hope the results of this study will inform key areas of future international, collaborative clinical research in Childhood Glaucoma.

  • early predictors of long term outcomes in Childhood Glaucoma
    Journal of Glaucoma, 2018
    Co-Authors: Ta C Chang, Elizabeth Hodapp, Alana L Grajewski, Kara M Cavuoto, Elizabeth A Vanner
    Abstract:

    PURPOSE A data-based staging system for Childhood Glaucoma is likely to improve the prediction of visual acuity and intraocular pressure (IOP) control outcomes. We investigated early clinical factors associated with poor long-term visual, and IOP control outcomes in early-onset Glaucoma as the initial steps to constructing a severity staging system. DESIGN Statistical modeling of retrospective case series data. PARTICIPANTS Glaucoma patients younger than 3 years of age who presented to Bascom Palmer Eye Institute between 1990 and 2010 with at least 5 years of follow up. METHODS Statistical modeling of retrospective case series data from first, second, third, 3-year, 5-year, and final visits. MAIN OUTCOME MEASURES Association of early clinical characteristics to final IOP-control outcomes and visual acuities. RESULTS A total of 26 eyes of 15 children were included. Nine of 15 (60%) of patients were male. Mean age at initial presentation: 9.98±10.55 months. Mean duration between initial and final visits: 11.13±3.55 years. By the third visit (mean 6.69 mo after presentation), presence of nystagmus, anterior segment dysgenesis (ASD) or having failed angle surgery increased the final LogMAR visual acuity by 0.76 (P=0.0516), 0.64 (P=0.0618), and 0.58 (P=0.0159), respectively. At year 3, failed amblyopia therapy, failed angle surgery, nystagmus, media opacity (MO), or ASD increased the final LogMAR by 1.30, 1.34, 1.21, 0.85, 0.64, respectively (all P<0.02). Failed angle surgery or MO increased the chance of uncontrolled IOP at the final visit (proportional odds ratio of 6.77 and 12.88, respectively). CONCLUSIONS In this pilot study of a modest size cohort, the presence of nystagmus, ASD or failed angle surgery early in the course of infantile-onset Glaucoma management predicted poor final visual outcome, whereas failed angle surgery and presence of MO predicted poor final IOP control. These predictors of poor outcomes will serve as the initial steps in constructing a severity staging system.

  • new classification system for pediatric Glaucoma implications for clinical care and a research registry
    Current Opinion in Ophthalmology, 2018
    Co-Authors: Allen D. Beck, Sharon F Freedman, Alana L Grajewski, Avrey Thau, Maureen Lloyd, Alex V Levin
    Abstract:

    Purpose of reviewThe Childhood Glaucoma Research Network (CGRN) has created a new classification system for Childhood Glaucoma that has become the first International Consensus Classification. The purpose of this review is to present this classification system and share its use to date.Recent Findin

  • Childhood Glaucoma surgery perioperative considerations
    2018
    Co-Authors: Maria Papadopoulos, Alana L Grajewski, Elena Bitrian, Sharon F Freedman
    Abstract:

    Managing Glaucoma in Childhood is one of the greatest challenges in the field of Glaucoma, especially its surgical treatment, itself a critical component of management. Most children with Glaucoma will require surgery in their lifetime, often in their Childhood years. The surgical repertoire for Childhood Glaucoma has remained relatively unchanged for many years, with most progress resulting from modifications to existing surgery. Each surgical technique has its advantages and disadvantages, with potentially good success rates when chosen appropriately and performed with meticulous attention to detail to minimize complications. The aim of surgery is to eliminate or bypass aqueous flow obstruction. The challenge of surgery is to balance greater success with fewer complications. To achieve this fine balance, the surgeon often modifies and develops a technique that is safe. Internationally, approaches to surgery for Childhood Glaucoma can vary, but these highly specialized operations should preferably be performed by a trained surgeon in centers with sufficient volume of patients to ensure surgical experience and skill, coupled with safe anesthesia.

  • a retrospective survey of Childhood Glaucoma prevalence according to Childhood Glaucoma research network classification
    Indian Journal of Ophthalmology, 2016
    Co-Authors: Ambika Hoguet, Alana L Grajewski, Elizabeth Hodapp, Ta Chen Peter Chang
    Abstract:

    Purpose: To evaluate the Childhood Glaucoma Research Network (CGRN) classification system and describe the prevalence of each subtype according to this classification. Materials and Methods: Retrospectively, the medical records of 205 consecutive Childhood Glaucoma and Glaucoma suspect patients at an urban tertiary care center were reviewed. The initial diagnosis and new diagnosis according to CGRN classification were recorded. Results: All patients fit one of the seven categories of the new classification. Seventy-one percent of diagnoses were changed upon reclassification. Twenty-three percent of patients had primary Glaucoma (juvenile open-angle Glaucoma and primary congenital Glaucoma [PCG]); 36% had secondary Glaucoma (Glaucoma associated with nonacquired ocular anomalies; Glaucoma associated with nonacquired systemic disease or syndrome; Glaucoma associated with acquired condition; and Glaucoma following cataract surgery); and 39% were Glaucoma suspect. Of the patients diagnosed with Glaucoma, PCG was the most common diagnosis, seen in 32% of patients. Conclusion: The CGRN classification provides a useful method of classifying Childhood Glaucoma.

Alex V Levin - One of the best experts on this subject based on the ideXlab platform.