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AimTo analyse long-term visual outcomes across different subtypes of primary congenital glaucoma (PCG).MethodsPatients with PCG with a minimum of 5-year follow-up post surgery were included in the study. Snellen visual acuity recordings taken at their last follow-up were analysed. We evaluated the results using Kaplan-Meier curves to predict the probability of maintaining good vision (as defined by a visual acuity of 6/18 or better) in our patients after 30-year follow-up. The results were also analysed to determine whether there were any differences in the long-term visual acuities with time between the neonatal and infantile PCG. We also analysed the reasons for poor visual outcomes.ResultsWe assessed a cohort of 140 patients with PCG (235 eyes) with an average follow-up of 127±62.8 months (range 60–400 months). Overall, the proportion of eyes with good visual acuity was 89 (37.9%), those with fair visual acuity between 6/60 and 6/18 was 41 (17.4%), and those with poor visual acuity (≤6/60) was 105 (44.7%). We found a significant difference (p=0.047) between neonatal and infantile patients with PCG whereby the neonatal cohort fared worse off in terms of visual morbidity. On Kaplan-Meier analysis, the cumulative probability of survival of a visual acuity of 6/18 or better was more among the infantile PCG in comparison to the neonatal PCG (p=0.039) eyes, and more among the bilateral than the unilateral affected eyes (p=0.029). Amblyopia was the most important cause for poor visual acuity as shown on a Cox proportional-hazards regression model.ConclusionsLong-term visual outcomes of infantile are better than neonatal PCG. Eyes with unilateral have worse visual outcomes compared with those with bilateral PCG because of the development of dense amblyopia.

To evaluate the Childhood Glaucoma Research Network (CGRN) classification system and describe the prevalence of each subtype according to this classification. 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. 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. The CGRN classification provides a useful method of classifying childhood glaucoma.

Background To describe the clinical characteristics and treatment of primary childhood glaucoma at Queen Elizabeth Central Hospital in Blantyre, Malawi. Methods A retrospective case notes review was undertaken of all medical records of patients aged less than 16 years with a diagnosis of primary glaucoma according to the Childhood Glaucoma Research Network Classification (CGRN) who presented from January 2016 to December 2018. The parameters extracted from the case files included age at presentation, sex, type of glaucoma, presenting complaints, laterality of ocular involvement, examination findings and the treatment modality instituted. The Mann-Whitney test was used to investigate factors associated with the intraocular pressure (IOP) in eyes that had a higher presenting IOP value compared to contralateral eyes. Results A total of 45 subjects (80 eyes) were identified, 42 with primary congenital glaucoma (PCG) and 3 with juvenile open angle glaucoma (JOAG). The mean age for the population was 2.6 years (S.D ± 3.7) and most of the patients were male, with a male-female ratio of 2:1. The majority of patients had bilateral disease (n = 35, 77.8%) with the commonest presenting complaint being a whitish appearance of the eye (57.5%). The eyes studied had a mean IOP of 30.1 mmHg (CI 27.4–32.9), a mean horizontal corneal diameter (HCD) of 13.6 mm (CI 13.1–14.2) and a mean cup-disc-ratio `(CDR) of 0.73 (CI 0.66–0.79). In addition, 62 eyes (77.5%) had corneal haze on examination. Most patients (n = 59, 73.8%) underwent a combined trabeculotomy – trabeculectomy surgery within the study period. The median presenting IOP was significantly higher with JOAG compared to PCG ( P  = 0.02). Conclusion PCG was the most common primary childhood glaucoma at Queen Elizabeth Central Hospital and most patients presented with bilateral eye involvement. Most of the eyes had corneal haze and JOAG was associated with a higher presenting IOP compared to PCG. Further studies to investigate the outcomes of combined trabeculotomy – trabeculectomy surgery in primary childhood glaucoma in Malawi are recommended.