The epidemiology of pediatric glaucoma: The Toronto experience

Background: This study was conceived to provide an insight into the spectru m of glaucoma in the pediatric population. We also set out to compare the s uccess of disease control and the prognosis for vision within the different diagnostic subgroups. This is the largest single population of children wi th glaucoma that has been so described and compared. Methods: The charts of children who were first seen between birth and age 16 years and who attend ed the Hospital for Sick Children with any form of glaucoma between January 1974 and January 1995 were reviewed and entered into the study. Results Da ta are presented for 306 children. Congenital glaucoma was the most common subtype, accounting for 38%. Patients with congenital glaucoma were young, had surgery, and had more operations than any other group except those with aniridia. Goniotomy offered a cure in 47.8% of the patients. A bimodal dis tribution reflected their visual performance. Patients with aphakic glaucom a, the next most prevalent group (20%), presented at an older age (4.5 year s). Surgical intervention was performed in 50% of these children. Nearly al l patients with Sturge-Weber syndrome (80%) had surgery. The following glau coma groups were associated with a poor visual outcome: aniridia, anterior segment developmental anomalies involving the cornea, uveitis with glaucoma other than steroid induced, retinopathy of prematurity, and persistent hyp erplastic primary vitreous. Steroid-induced glaucoma and anterior segment d ysgenesis, excluding Peters anomaly, had uniformly good outcomes. Conclusio n: The ability to control glaucoma in childhood and visual prognosis is hig hly variable. Particular diagnostic categories do consistently well and som e do poorly.