Primary Angle Closure Glaucoma in Children: Four Cases and a Review of Pediatric Plateau Iris Configuration
Unikora Yang, MD; Bibiana J. Reiser, MD
Children’s Hospital Los Angeles, Keck School of Medicine,
University of Southern California, Los Angeles
Introduction: Glaucoma, and subsequently angle closure, is rare in children.1 We describe two pairs of siblings with angle closure glaucoma from a primary anatomical predisposition and review the differences between pediatric and adult management.
Methods: The first sibling pair presented with plateau iris configuration and anterior positioning of the lenticular zonules resulting in pupillary block. The second sibling pair was initially diagnosed with juvenile open angle glaucoma, but was found to have shallow anterior chambers, more consistent with chronic angle closure glaucoma.
Results: Cases 1 and 2 developed acute angle closure glaucoma requiring peripheral iridectomies. Postoperatively, they had patent iridectomies, but continued to have intermittent elevated intraocular pressures. Cases 3 and 4 were medically managed for chronic angle closure glaucoma and continued to have normal intraocular pressures.
Discussion: Children with acute angle closure are usually unable to tolerate a YAG laser peripheral iridotomy, thus requiring surgical iridectomies.2 Unlike adults, children are left phakic since they tend to have functionally accommodating lenses. To preserve the lens, a shunt is placed to control intraocular pressures rather than undergoing a lensectomy.3
Conclusion: Cases 1 and 2 highlight the differences in surgical management of pediatric and adult acute angle closure. Cases 3 and 4 remain well managed medically, which may be due to earlier presentation and aggressive initiation of therapy, and demonstrate the differences between acute and chronic angle closure. All four cases underscore the importance of re-evaluation of diagnoses and tonometry as a routine part of pediatric screening.
1. Chang BM, Liebmann JM, Ritch R. Angle closure in younger patients. Transactions of the American Ophthalmological Society. 2002;100:201-214.
2. Liebmann JM, Ritch R. Laser surgery for angle closure glaucoma. Semin Ophthalmol. 2002;17:84-91.
3. Tarongoy P, Ho CL, Walton DS. Angle-closure Glaucoma: The Role of the Lens in the Pathogenesis, Prevention, and Treatment. Survey of Ophthalmology. 2009;54(2):211-225.