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Glaucoma in children

Glaucoma in children

Increase in the intraocular pressure that causes vision loss in children is called glaucoma.

There are many causes of glaucoma in children (as mentioned above)

  • The glaucoma affects 1 in 10,000 live births approximately. The child presents with watering (tearing) from the eyes, increased size of the cornea and inability to tolerate the light.
  • This triad of signs is confirmatory and it is essentially accompanied by damage to the optic nerve.
  • Invariably, if not treated the child becomes blind and the eye becomes disfigured and painful
  • There are various reasons for glaucoma in children. By far the commonest cause is poor development of outflow channels that does not allow the intraocular fluid (aqueous humor) to flow out.
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Measuring the intraocular (eye) pressure with a Handheld Perkins Tonometer

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Handheld slit lamp for microscopic examination of the eye- Crucial for evaluating and monitoring glaucoma before as well as after surgery

At Jyotirmay Eye Clinic we use very specialised instruments to diagnose and treat these kids.

  • Glaucoma in children is almost invariably an urgent surgery.
  • The glaucoma surgery is unique, unlike what is done in adults.
  • Medications – eye drops and oral medicines are usually started to control the eye pressure until the child is started until the operation is performed.

Unique facilities at Jyotirmay Eye Clinic

  • Sevoflurane (world’s safest gas) anesthesia is available for the child’s safety.
  • Philips (USA) VM8 Sure sign monitor is available for intraoperative monitoring for unparalleled child safety
  • Glaucoma management in children is far beyond the primary glaucoma surgery. Children need constant assessment for vision (lazy eye), intraocular pressure monitoring and squint assessment. Our goal remains to rehabilitate the child to the best visual potential over the years.
  • Special techniques for pediatric glaucoma surgery: called canaloplasty of performing the glaucoma surgery in children that we believe increases the safety and accuracy of the surgery by preventing a unique complication called iris prolapse during the surgery.

Trabeculotomy with trabeculectomy: Watch the video: https://www.youtube.com/watch?v=0Bqr0WM-QeM

Harms trabeculotome

Goniotomy

Glaucoma implant surgery (eg Ahmed glaucoma valve)

Special instruments to examine children even after surgery:

  • Handheld slit lamp: Following up a child after glaucoma surgery, needs close assessment of the internal structures of the eye as well to see the new area of filtration which has been surgically created. Thus, a hand held slit lamp remains crucial to the management in the long term.
  • Perkins handheld tonometer: this is the gold standard method to measure the eye pressure by a technique called Applanation tonometry and since it is hand held, it allows us to measure the eye pressure even in these young children
  • Icare 200 (latest model and first in Mumbai-Thane region): reduces the need for repeated anesthesia and sedation to measure intraocular pressure in children. This model has been specifically procured in the clinic to give reliable readings even in children who are asleep.

In general the results of glaucoma surgery in children are quite satisfying due to modern technology and huge expertise. One of the most important determinants of the outcome is how quickly the surgery is performed.

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