Juvenile Glaucoma

Juvenile glaucoma is a rare juvenile-onset open-angle glaucoma (JOAG) often found associated with myopia that shows autosomal dominant transmission. This entity is one of a group of pediatric glaucomas known as primary developmental glaucoma.

Differential diagnoses of the primary developmental glaucomas

Primary congenital glaucoma

• Newborn primary congenital glaucoma

• Infantile primary congenital glaucoma

• Late-recognized primary congenital glaucoma

Autosomal-dominant juvenile open-angle glaucoma

Primary angle-closure glaucoma

Primary glaucoma associated with systemic abnormalities

• Sturge-Weber syndrome

• Neurofibromatosis (NF-1)

• Stickler syndrome

• Oculocerebrorenal (Lowe) syndrome

• Rieger syndrome

• SHORT syndrome

• Hepatocerebrorenal (Zellweger) syndrome

• Marfan syndrome

• Rubinstein-Taybi syndrome

• Infantile glaucoma associated with retardation and paralysis

• Oculodentodigital dysplasia

• Open-angle glaucoma associated with microcornea and absent sinuses

• Mucopolysaccharidosis

• Trisomy 13

• Duplication 3q syndrome

• Trisomy 21 (Down syndrome)

• Cutis marmorata telangiectatica congenita

• Warburg syndrome

• Kniest syndrome (skeletal dysplasia)

• Michel syndrome

• Nonprogressive hemiatrophy

• PHACE syndrome

• Sotos syndrome

• Linear scleroderma

• GAPO syndrome

• Roberts pseudothalidomide syndrome

• Wolf-Hirschhorn (4p-) syndrome

• Robinow syndrome

• Nail-patella syndrome

• Cranio-cerebello-cardiac syndrome (3C syndrome)

• Brachmann-de Lange syndrome

• Rothmund-Thomson syndrome

• 9p deletion syndrome

• Phakomatosis pigmentovascularis (PPV)

Primary glaucoma associated with ocular abnormalities

• Congenital pupillary-iris-lens membrane syndrome

• Aniridia (congenital and acquired glaucoma)

• Congenital ocular melanosis

• Sclerocornea

• Iridotrabecular dysgenesis

• Peters syndrome

• Congenital iris ectropion syndrome

• Posterior polymorphous dystrophy

• Idiopathic or familial elevated episcleral venous pressure

• Anterior corneal staphyloma

• Congenital microcoria with myopia

• Congenital hereditary endothelial dystrophy

• Congenital hereditary iris stromal hypoplasia

• Axenfeld-Rieger anomaly

Secondary acquired glaucomas in the pediatric age group

Traumatic glaucoma

• Acute glaucoma (angle concussion, hyphema, ghost cell glaucoma)

• Late-onset glaucoma with angle recession

• Arteriovenous fistula

Glaucoma secondary to intraocular neoplasm

• Retinoblastoma

• Juvenile xanthogranuloma

• Leukemia

• Melanoma of ciliary body

• Melanocytoma

• Iris rhabdomyosarcoma

• Aggressive nevi of the iris

• Medulloepithelioma

• Mucogenic glaucoma with iris stromal cyst

Glaucoma secondary to chronic uveitis

• Open-angle glaucoma

• Angle-blockage glaucoma (synechial angle closure, iris bombé with pupillary block, trabecular endothelialization)

Lens-related glaucoma

• Subluxation-dislocation and pupillary block (Marfan syndrome, homocystinuria, Weill-Marchesani syndrome, axial subluxation with progressive high myopia)

• Spherophakia and pupillary block

• Phacolytic glaucoma

Glaucoma following lensectomy for congenital cataracts

• Pupillary block

• Chronic open-angle glaucoma following infantile lensectomy

Steroid-induced glaucoma

Glaucoma secondary to rubeosis

• Retinoblastoma

• Coats disease

• Medulloepithelioma

• Familial exudative vitreoretinopathy

• Chronic retinal detachment

Secondary angle-closure glaucoma

• Cicatricial retinopathy of prematurity (ROP)

• Microphthalmos

• Nanophthalmos

• Retinoblastoma

• Persistent hyperplastic primary vitreous

• Congenital pupillary-iris-lens membrane

• Topiramate therapy

• Ciliary body cysts

• Following laser therapy for ROP

Malignant glaucoma

Glaucoma associated with increased venous pressure

• Cavernous or dural A-V shunt

• Orbital disease

Glaucoma secondary to intraocular infection

• Acute recurrent toxoplasmosis

• Acute herpetic iritis

• Endogenous endophthalmitis

• Maternal rubella infection

Glaucoma secondary to undetermined etiology

• Iridocorneal endothelial syndrome (ICE) ^[1]

Increased intraocular pressure (IOP) is caused by impaired outflow of aqueous humor through the trabecular meshwork into the Schlemm canal. On clinical examination with gonioscopy, the filtration tissues within the anterior chamber angle appear normal in persons with juvenile glaucoma. ^[2] Pathologic examination has found thickened tissue and abnormal deposit of extracellular tissue in the trabecular meshwork between the anterior chamber and the Schlemm canal.

Following recognition of linkage of the gene for juvenile glaucoma on chromosome 1 (band 1q21-q31), the gene itself was identified and related to mutations found in the trabecular meshwork inducible glucocorticoid response (TIGR) gene in patients with juvenile glaucoma. This gene, now called myocilin, codes for the glycoprotein myocilin that is found in the trabecular meshwork and other ocular tissues. The normal function of myocilin and its role in causing glaucoma is undetermined. In studies of consanguineous populations, Khan et al concluded that mutation in CYP1B1 rather than mutation in MYOC can sometimes underlie familial primary juvenile glaucoma. ^{[3, 4, 5]}

Frequency

United States

Juvenile glaucoma has an estimated occurrence of 1 per 50,000 persons. It is rare when compared in frequency to other types of childhood glaucoma.

Mortality/Morbidity

No risk of mortality exists with juvenile glaucoma. Loss of vision is possible without early diagnosis and treatment.

Race

Juvenile glaucoma has been observed in Japanese, French, French Canadian, Caucasian-American, Asian-American, Hispanic-American, African-American, Panamanian, German, English, Irish, Danish, Italian, and Spanish families.

Young black patients with juvenile glaucoma, especially when myopic, are more susceptible to glaucomatous damage than are whites. ^[6]

Sex

Juvenile glaucoma probably occurs with equal frequency and severity in males and females.

Age

Patients with juvenile glaucoma show no evidence of congenital or infantile glaucoma. When candidate children are monitored carefully in families with a history of glaucoma, the onset of abnormal eye pressures occurs in children aged 5-10 years. In sporadic patients or those with no known family history of juvenile glaucoma, recognition of this glaucoma has occurred more often in adolescence or during the early adult years.

With an early diagnosis of glaucoma, the prognosis is excellent for retention of vision in patients. ^{[7, 8]}

Family members of patients with juvenile glaucoma must be informed of their risk and the risk of glaucoma in offspring.

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