CHILDHOOD GLAUCOMA: REVIEW OF THE CASE RECORDS OF THE OPHTHALMOLOGY CLINIC OF PAVIA FROM 2000 TO 2015 AND VISUAL OUTCOME EVALUATION

Purpose: The purpose of this study has been to analyse the childhood glaucoma case records of the Ophthalmology Clinic of Pavia, to evaluate the course of the disease and the functional outcome of the patients. Materials: We have collected 52 patients classified as “childhood glaucoma”, aged 3 to 24 years old, 24 of whom were excluded because they were not affected by this disease. Methods: We have analysed the clinical features of these patients at diagnosis, focusing on intraocular pressure, corneal diameter and the inspection of the anterior segment and of the fundus oculi. Subsequently we have analysed the functional outcome after medical or surgical treatment, through the results of the visual evoked potential tests, the visual acuity and the final value of intraocular pressure. Results: Of the 52 patients in our original sample, 24 were excluded and the remaining 28 were divided into classes according to their specific diagnosis: 10 primary congenital glaucoma cases, 4 cases of glaucoma associated with other ocular malformations, 11 secondary glaucoma patients. Of the associated glaucoma cases, 3 are affected by Axenfeld-Rieger syndrome and 1 by aniridia. Among secondary glaucoma cases, instead, we found a high prevalence of congenital cataract (9 patients), 1 patient with neurofibromatosis I and 1 patient with Blau syndrome. One last category that has emerged includes 3 patients affected by megalocornea, a condition that must be considered in the differential diagnosis of childhood glaucoma. Conclusions: After a thorough evaluation of the childhood glaucoma cases, we state that, as reported in the literature, primary congenital glaucoma is a severe disease, with a poor prognosis and that it causes severe visual deficits that can rarely and poorly improve, even with an early diagnosis. Glaucoma associated with other ocular malformations has shown very similar features to primary congenital glaucoma. Moreover, we have seen that congenital cataract can be complicated by secondary childhood glaucoma, of which it is the most common cause, and that also in this case the visual recovery is very poor, both due to the glaucomatous damage and to the severe deficits caused by the cataract per se.