Childhood Angle Closure: Etiology and Treatment Outcomes from a Large Series Spanning over 20 Years.

PURPOSE: To characterize the etiologies of childhood angle closure (CAC) and to compare the long-term outcomes of glaucoma drainage devices (GDDs) vs. lens surgery ± goniosynechialysis (GSL) in the management of CAC-associated glaucoma.

DESIGN

Retrospective multicenter cohort study.

PARTICIPANTS

Patients under 18 years of age diagnosed with CAC between 2003 and 2023.

METHODS

Childhood angle-closure cases were categorized by acute vs. chronic presentation and by primary vs. secondary causes. Treatment approaches were analyzed, and surgical outcomes of GDD implantation and lens extraction ± GSL were compared in CAC glaucoma, excluding cases of glaucoma following cataract surgery (GFCS).

MAIN OUTCOME MEASURES: The primary outcome was the distribution of CAC etiologies in pediatric patients. The secondary outcomes included the 5-year complete and qualified success rates of GDDs and lens surgery ± GSL in CAC glaucoma, changes in intraocular pressure, and the number of glaucoma medications required postoperatively.

RESULTS

A total of 103 patients (159 eyes) were included, with a slight female predominance (51.5%) and a mean age at diagnosis of 10.3 ± 5.6 years. Acute CAC was observed in 5.7% of eyes, all of which were secondary. The remaining 94.3% had chronic CAC, most associated with retinopathy of prematurity (ROP, 26.7%). Among those with glaucoma, ROP was the leading cause (21.9%), followed by GFCS (16.0%) and uveitis (7.6%). Surgical intervention was required in 63.3% of CAC glaucoma cases, with GDD implantation being the most frequent (38.6%), followed by lens surgery (22.7%, 85% of which included GSL), peripheral iridotomy (15.9%), and trabeculectomy (7.9%). Lens surgery ± GSL demonstrated a significantly higher complete success rate at 5 years compared to GDD (35.5% vs. 9.5%; P = 0.006), while no significant differences were found in qualified success (P = 0.2) or serious surgical complications between the 2 groups.

CONCLUSIONS

Childhood angle closure is primarily chronic and secondary, most often associated with ROP. Surgical intervention is frequently required in CAC-related glaucoma. Our findings suggest that lens surgery ± GSL may achieve superior long-term complete success compared to GDDs, with a comparable safety profile. However, given the multiple etiologies of glaucoma, the choice of surgical approach should be individualized and guided by the underlying etiology and clinical judgment FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.