Coviltir Valeria, Marinescu Maria Cristina, Urse Bianca Maria, Burcel Miruna Gabriela
Ophthalmology Discipline, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania.
Clinical Hospital for Ophthalmological Emergencies, 1 Lahovari Place, 010464 Bucharest, Romania.
Diagnostics (Basel). 2025 Jan 28;15(3):308. doi: 10.3390/diagnostics15030308.
Childhood glaucoma encompasses a group of rare but severe ocular disorders characterized by increased intraocular pressure (IOP), posing significant risks to vision and quality of life. Primary congenital glaucoma has a prevalence of one in 10,000-68,000 people in Western countries. More worryingly, it is responsible for 5-18% of all childhood blindness cases. According to the Childhood Glaucoma Research Network (CGRN), this spectrum of disease is classified into primary glaucoma (primary congenital glaucoma and juvenile open-angle glaucoma) and secondary glaucomas (associated with non-acquired ocular anomalies, non-acquired systemic disease, acquired conditions, and glaucoma after cataract surgery). They present very specific ocular characteristics, such as buphthalmos or progressive myopic shift, corneal modifications such as Haab striae, corneal edema or increased corneal diameter, and also glaucoma findings including high intraocular pressure, specific visual fields abnormalities, and optic nerve damage such as increased cup-disc ratio, cup-disc ratio asymmetry of at least 0.2 and focal rim thinning. Surgical intervention remains the cornerstone of treatment, and initial surgical options include angle surgeries such as goniotomy and trabeculotomy, aimed at improving aqueous outflow. For refractory cases, trabeculectomy and glaucoma drainage devices (GDDs) serve as second-line therapies. Advanced cases may require cyclodestructive procedures, including transscleral cyclophotocoagulation, reserved for eyes with limited visual potential. All in all, with appropriate management, the prognosis of PCG may be quite favorable: stationary disease has been reported in 90.3% of cases after one year, with a median visual acuity in the better eye of 20/30. Immediate recognition of the specific signs and symptoms by caregivers, primary care providers, and ophthalmologists, followed by prompt diagnosis, comprehensive surgical planning, and involving the caregivers in the follow-up schedule remain critical for optimizing outcomes in childhood glaucoma management.
儿童青光眼是一组罕见但严重的眼部疾病，其特征为眼内压（IOP）升高，对视力和生活质量构成重大风险。在西方国家，原发性先天性青光眼的患病率为万分之一至六万八分之一。更令人担忧的是，它占所有儿童失明病例的5%-18%。根据儿童青光眼研究网络（CGRN），这种疾病谱分为原发性青光眼（原发性先天性青光眼和青少年开角型青光眼）和继发性青光眼（与非后天性眼部异常、非后天性全身性疾病、后天性疾病以及白内障手术后青光眼相关）。它们具有非常特殊的眼部特征，如眼球增大或渐进性近视偏移、角膜改变如哈布条纹、角膜水肿或角膜直径增加，以及青光眼表现，包括高眼压、特定视野异常和视神经损伤，如杯盘比增加、杯盘比不对称至少0.2以及局部视盘边缘变薄。手术干预仍然是治疗的基石，初始手术选择包括房角手术，如房角切开术和小梁切开术，旨在改善房水流出。对于难治性病例，小梁切除术和青光眼引流装置（GDDs）作为二线治疗方法。晚期病例可能需要进行睫状体破坏手术，包括经巩膜睫状体光凝术，适用于视力潜力有限的眼睛。总体而言，通过适当的管理，原发性先天性青光眼的预后可能相当良好：据报道，一年后90.3%的病例病情稳定，较好眼的中位视力为20/30。护理人员、初级保健提供者和眼科医生立即识别特定的体征和症状，随后进行及时诊断、全面的手术规划，并让护理人员参与随访计划，对于优化儿童青光眼管理的结果仍然至关重要。
