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Bayoumi N, Khalil AK, Elsayed EN. Combined trabeculotomy-trabeculectomy for glaucoma after congenital cataract surgery: long-term results. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:194-200. [PMID: 36965510 DOI: 10.1016/j.jcjo.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/13/2023] [Accepted: 02/26/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE The aim of this study was to report on the long-term (>5 years) results of surgery for glaucoma after congenital cataract surgery. DESIGN Retrospective. METHODS A chart review was conducted of all children operated on for glaucoma after congenital cataract surgery in the Pediatric Ophthalmology Service of the Ophthalmology Department of Alexandria main University Hospital in Alexandria, Egypt, between 2005 and 2014 who completed 5 years of follow-up. Demographic, clinical, and operative data were retrieved from the medical records. Success was defined by stability and (or) reversal of optic nerve cupping in relation to presentation and, if this information was not available, by an intraocular pressure (IOP) less than the presenting IOP and less than 16 mm Hg with (true) or without (qualified) IOP-lowering therapy. RESULTS The records of 48 children were reviewed. Thirty-two eyes of 24 children had completed at least 5 years of follow-up and were included in the study. The mean age (±SD) of the study children was 11.6 ± 11.3 months (range, 3.2-52.0 months) at presentation, and the mean (±SD) follow-up was 105.5 ± 31.4 months (range, 60-156 months). Of 47 glaucoma surgical procedures in total, combined angle and filtering surgery with antimetabolite was the most common procedure performed (n = 30;63.8%). Annual success percentages from the fifth year onward to the thirteenth year were 69.6%, 68.8%, 77.8%, 50.0%, 71.4%, 60.0%, 50.0%, 83.3%, and 50.0%, respectively. CONCLUSIONS Surgery for glaucoma after congenital cataract surgery remains safe and successful for 13 years after surgery.
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Affiliation(s)
- Nader Bayoumi
- From the Department of Ophthalmology, Alexandria University Faculty of Medicine, Alexandria, Egypt.
| | - Ahmad K Khalil
- Department of Ophthalmology and the Glaucoma Service, Research Institute of Ophthalmology, Giza, Egypt
| | - Eman Nabil Elsayed
- From the Department of Ophthalmology, Alexandria University Faculty of Medicine, Alexandria, Egypt
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Elhusseiny AM, Hassan AK, Azhari JO, Elkheniny FD, Chauhan MZ, Chang TC, VanderVeen DK, Oke I, Mansour M, Pakravan M, Shaarawy T, Sallam AB. Ahmed and Baerveldt Glaucoma Drainage Devices in Childhood Glaucoma: A Meta-Analysis. J Glaucoma 2023; 32:686-694. [PMID: 37172011 DOI: 10.1097/ijg.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/30/2023] [Indexed: 05/14/2023]
Abstract
PRCIS The effectiveness of Ahmed glaucoma valve (AGV) and Baerveldt glaucoma implant (BGI) was comparable in the management of childhood glaucoma over the long term despite initial better success rate with BGI. There were higher tube block and retraction rates in the BGI group and higher tube exposure rates in the AGV group. PURPOSE To evaluate the outcomes and safety of AGV and BGI in childhood glaucoma. MATERIALS AND METHODS We performed a systematic literature review of publications from 1990 to 2022 in PubMed, EMBASE, ClinicalTrials.gov, Ovid MEDLINE, Cochrane CENTRAL, and google scholar for studies evaluating AGV and BGI in childhood glaucoma. Primary outcome measures were intraocular pressure (IOP) reduction and glaucoma medication reduction. The secondary outcome measures were the success rates and incidence of postoperative complications. We conducted a meta-analysis using a random effects model. RESULTS Thirty-two studies met the inclusion criteria. A total of 1480 eyes were included. The mean IOP reduction was 15.08 mm Hg ( P < 0.00001) for AGV and 14.62 ( P < 0.00001) for the BGI group. The mean difference between pre and postoperative glaucoma medications was 1 ( P < 0.00001) fewer medications in the AGV group and 0.95 ( P < 0.0001) fewer medications in the BGI group. There was a lower success rate in the AGV versus BGI groups at 2 years [63% vs 83%, respectively ( P < 0.0001) and 3 years (43% vs 79%, respectively ( P < 0.0001)]; however, the success was higher for AGV at 5 years (63% vs 56% in the BGI group, P < 0.001). The incidence of postoperative complications was comparable in the AGV and BGI groups, with rates of 28% and 27%, respectively. CONCLUSIONS The IOP and glaucoma medication reduction, success rates, and incidence of postoperative complications were comparable in Ahmed and Baerveldt groups. Most literature comes from retrospective low-quality studies on refractory childhood glaucoma. Further larger cohort studies are needed.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Amr K Hassan
- Department of Ophthalmology, South Valley University, Qena
| | - Jamal O Azhari
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute
| | | | | | - Ta C Chang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Munthir Mansour
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Tarek Shaarawy
- Geneva University Hospitals (HUG), University of Geneva, Geneva, Switzerland
| | - Ahmed B Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute
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Shen R, Li VSW, Wong MOM, Chan PPM. Pediatric Glaucoma-From Screening, Early Detection to Management. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020181. [PMID: 36832310 PMCID: PMC9954748 DOI: 10.3390/children10020181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Pediatric glaucoma (PG) covers a rare and heterogeneous group of diseases with variable causes and presentations. Delayed diagnosis of PG could lead to blindness, bringing emotional and psychological burdens to patients' caregivers. Recent genetic studies identified novel causative genes, which may provide new insight into the etiology of PG. More effective screening strategies could be beneficial for timely diagnosis and treatment. New findings on clinical characteristics and the latest examination instruments have provided additional evidence for diagnosing PG. In addition to IOP-lowering therapy, managing concomitant amblyopia and other associated ocular pathologies is essential to achieve a better visual outcome. Surgical treatment is usually required although medication is often used before surgery. These include angle surgeries, filtering surgeries, minimally invasive glaucoma surgeries, cyclophotocoagulation, and deep sclerectomy. Several advanced surgical therapies have been developed to increase success rates and decrease postoperative complications. Here, we review the classification and diagnosis, etiology, screening, clinical characteristics, examinations, and management of PG.
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Affiliation(s)
- Ruyue Shen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Venice S. W. Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Mandy O. M. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Poemen P. M. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-5807
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Jomar DE, Al-Shahwan S, Al-Beishri AS, Freidi A, Malik R. Risk Factors for Glaucoma Drainage Device Exposure in Children: A Case-Control Study. Am J Ophthalmol 2023; 245:174-183. [PMID: 36002072 DOI: 10.1016/j.ajo.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify the risk factors for glaucoma drainage device (GDD) exposure in children. DESIGN Retrospective case-control study. METHODS The study population comprised children (one eye each) who presented with a history of GDD exposure to a tertiary care eye hospital over the period January 2014 to January 2020. Consecutive children (age <18 years) were included. A control group from the same time period (children without GDD exposure) were included in the ratio of 5 controls to every 1 case of exposure. The main outcome measures included risk factors for exposure (univariate and multivariate analysis). RESULTS A total of 21 eyes (of 21 children with implant exposure) and 115 eyes (of 115 children without exposure) were included in this study. During the same study period, a total of 494 eyes had undergone GDD implantation, giving an estimated incidence of exposure of 4.25%). In the bivariate analysis, GDD exposure was associated with multiple previous ocular surgeries (P = .001), longer follow-up duration (P < .001), combined procedure at the time of primary implantation (P = .002), and a younger age at the time of primary implantation (P = .006). The former 3 risk factors continued to prove a statistically significant association on multivariable regression analysis. Postoperative use of eye lubricants was more common among children in the control group (P = .007). CONCLUSION In pediatric glaucoma patients, younger age and combined procedure at the time of primary GDD implantation, in addition to multiple previous ocular surgeries, were associated with greater risk of implant exposure. Postoperative use of eye lubricants may be protective.
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Affiliation(s)
- Deema E Jomar
- From the Glaucoma Division, King Khaled Eye Specialist Hospital (D.E.J., S.A.-S., A.S.A.-B., R.M.), Riyadh, Saudi Arabia
| | - Sami Al-Shahwan
- From the Glaucoma Division, King Khaled Eye Specialist Hospital (D.E.J., S.A.-S., A.S.A.-B., R.M.), Riyadh, Saudi Arabia
| | - Ali S Al-Beishri
- From the Glaucoma Division, King Khaled Eye Specialist Hospital (D.E.J., S.A.-S., A.S.A.-B., R.M.), Riyadh, Saudi Arabia
| | - Alia Freidi
- Faculty of Health Sciences, American University of Beirut (A.F.), Beirut, Lebanon
| | - Rizwan Malik
- From the Glaucoma Division, King Khaled Eye Specialist Hospital (D.E.J., S.A.-S., A.S.A.-B., R.M.), Riyadh, Saudi Arabia; Department of Ophthalmology and Visual Science, University of Alberta (R.M.), Edmonton, Alberta, Canada; Department of Ophthalmology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
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Liu Q, Liu C, Li H, Yang X, Dong Y, Feng X, Cheng W. Clinical Analysis of Pediatric Glaucoma in Central China. Front Med (Lausanne) 2022; 9:874369. [PMID: 35433729 PMCID: PMC9010614 DOI: 10.3389/fmed.2022.874369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeWe aimed to describe the characteristics, epidemiology, management, and outcomes of glaucoma in pediatric patients in central China.MethodsThis study retrospectively analyzed inpatients with pediatric glaucoma at Henan Provincial People's Hospital, Henan Eye Institute, and Henan Eye Hospital between 2017 and 2020.ResultsOverall, 239 cases (276 eyes) of pediatric glaucoma in patients, comprising 87 girls (36.40%) and 152 boys (63.60%) were analyzed. The mean age was 6.65 ± 4.46, and 2.93% of the patients had a family history of glaucoma. Primary congenital glaucoma (PCG) was the most common type of glaucoma, followed by traumatic glaucoma in 8.33% of the patients, which was considered secondary glaucoma. The most common signs and symptoms were elevated intraocular pressure (IOP) and eye pain. Trabeculotomy (Trab) and microcatheter-assisted 360° trabeculotomy (MAT) combined with Trab were the most commonly performed surgeries. The IOP of patients with PCG, juvenile open-angle glaucoma (JOAG), and secondary glaucoma were 15.27 ± 7.48 mmHg, 17.16 ± 10.05, and 18.65 ± 8.55, respectively, at the final follow up. The rate of re-operations in patients with PCG, JOAG, and secondary glaucoma were 9.15%, 6.78%, and 4.69%, respectively. The mean visual acuity of the eyes with PCG, JOAG, and secondary glaucoma was 0.79 ± 0.68, 0.51 ± 0.48, and 0.53 ± 0.50, respectively.ConclusionPCG, JOAG, and traumatic glaucoma were the most prevalent subtypes in patients with pediatric glaucoma in central China. Trab and MAT combined with Trab were the most common interventions used in this study. Pediatric amblyopia might require full attention during the entire treatment, especially after glaucoma surgery. Effective preventive measures and more public education on glaucoma prevention and the importance of early diagnosis and treatment is necessary.
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Gurney SP, Ahmad M, Makanjuola T, Ramm L, Parulekar MV. Long-term Efficacy of Mitomycin C Augmented Trabeculectomy in a Mixed Pediatric Glaucoma Cohort. J Glaucoma 2021; 30:357-361. [PMID: 33337719 DOI: 10.1097/ijg.0000000000001759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
PRECIS This paper reports a retrospective consecutive case series investigating the efficacy of Mitomycin C-augmented trabeculectomy in the treatment of primary and secondary pediatric glaucoma in a mixed etiology, multiethnic cohort of patients. PURPOSE To evaluate the long-term efficacy and safety of Mitomycin C-augmented trabeculectomy in a mixed, tertiary-referral, pediatric glaucoma cohort. METHODS Retrospective consecutive review of all children (37 eyes) undergoing Mitomycin C-augmented trabeculectomy by a single surgeon between 2008 and 2016. Seventeen eyes (45.9%) had primary congenital glaucoma, and 20 eyes (54.1%) had secondary glaucoma. The median age at surgery was 11 months (range, 2 to 146). The mean follow-up was 69.2±4.7 months (range, 3.5 to 107.9). RESULTS Overall, trabeculectomy was successful in 80.6% of eyes at 12 months, 60.5% at 3 years, and 57.5% at 5 years. 45.9% cases (17 eyes) required further laser or surgery for uncontrolled intraocular pressure (IOP) and were therefore deemed as failures. The time to failure ranged from 0.4 to 65.1 months (mean, 22.2±5.1 mo). The proportion of children achieving visual acuity of 1.0 LogMAR equivalent or better increased from 43.2% preoperatively to 63.6% at 1 year and 68% at 5 years. The mean IOP reduced from 24.85±0.88 mm Hg preoperatively to 15.14±0.94 mm Hg at 3 months (39% reduction) and 17.42±1.08 mm Hg at 5 years (30% reduction). IOP-lowering medication requirement reduced from 4.14±0.20 agents preoperatively to 0.84±0.22 at 3 months (80% reduction) and 1.78±0.36 at 5 years (57% reduction). There were no sight-threatening complications such as hyphaema, bleb leak, chronic hypotony, endophthalmitis, retinal detachment, or loss of light perception. CONCLUSIONS This study provides valuable evidence that Mitomycin C-augmented trabeculectomy is safe and effective as a treatment of primary or secondary pediatric glaucoma, with particularly encouraging results in cases of secondary glaucoma. Trabeculectomy offers the potential for delaying or avoiding glaucoma drainage device surgery in a significant proportion of children.
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Affiliation(s)
- Sam P Gurney
- Department of Paediatric Ophthalmology, Birmingham Women's and Children's Hospital, Birmingham
| | - Mohammad Ahmad
- Department of Paediatric Ophthalmology, Birmingham Women's and Children's Hospital, Birmingham
| | - Taiwo Makanjuola
- Department of Paediatric Ophthalmology, Birmingham Women's and Children's Hospital, Birmingham
| | - Laura Ramm
- Department of Paediatric Ophthalmology, Birmingham Women's and Children's Hospital, Birmingham
| | - Manoj V Parulekar
- Department of Paediatric Ophthalmology, Birmingham Women's and Children's Hospital, Birmingham
- Department of Ophthalmology, Oxford University Hospitals NHS Trust, Oxford, UK
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Vu DM, Stoler J, Rothman AL, Chang TC. A Service Coverage Analysis of Primary Congenital Glaucoma Care Across the United States. Am J Ophthalmol 2021; 224:112-119. [PMID: 33340505 PMCID: PMC10619983 DOI: 10.1016/j.ajo.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess the number of infants at risk of delayed primary congenital glaucoma (PCG) evaluation due to long travel times to specialists. DESIGN Cross-sectional geospatial service coverage analysis. METHODS All American Glaucoma Society (AGS) and American Association for Pediatric Ophthalmology and Strabismus (AAPOS) provider locations were geocoded using each organization's member directory. Sixty-minute drive time regions to providers were generated using ArcGIS Pro (Esri). The geographic intersection of AGS and AAPOS service areas was computed because patients typically require visits to both types of specialists. American Community Survey data were then overlaid to estimate the number of infants within and beyond the AGS/AAPOS service areas. RESULTS One thousand twenty-nine AGS and 1,040 AAPOS provider locations were geocoded. The analysis yielded 944,047 infants age 0-1 year (23.6%) who live beyond the AGS/AAPOS service areas. Therefore, approximately 14-94 new PCG cases/year may be at risk of delayed diagnosis as a result of living in a potential service desert. Compared with children living within the AGS/AAPOS service areas, children aged <6 years in these potential service deserts were more likely to live in households earning below the US federal poverty level, lack health insurance, and live in a single-parent home. These communities are disproportionately likely to experience other rural health disparities and are more prevalent across the Great Plains. CONCLUSION Service coverage analysis is a useful tool for identifying underserved regions for PCG referrals and evaluation. These data may assist in targeting screening programs in low access areas for pediatric glaucoma care.
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Affiliation(s)
- Daniel M Vu
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA.
| | - Justin Stoler
- Department of Geography and Regional Studies, University of Miami, Coral Gables, Florida, USA; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
| | - Ta Chen Chang
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
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Berger O, Mohamed-Noriega J, Low S, Daniel MC, Petchyim S, Papadopoulos M, Brookes J. From Conventional Angle Surgery to 360-Degree Trabeculotomy in Pediatric Glaucoma. Am J Ophthalmol 2020; 219:77-86. [PMID: 32569736 DOI: 10.1016/j.ajo.2020.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the transition from conventional angle surgery (CAS), trabeculotomy with rigid probe or goniotomy, to 360-degree trabeculotomy assisted with microcatheter (MCT). DESIGN Retrospective comparative interventional case series. METHODS Review of consecutive children with glaucoma undergoing angle surgery, including cases with previous surgery, from January 2012 until March 2018 at Moorfields Eye Hospital. Main outcome measure was success rate, defined as intraocular pressure (IOP) ≤21 mm Hg with a minimum of 20% of IOP reduction and no further glaucoma surgery (complete success: without the need of glaucoma drops; qualified success: drops were needed to keep the IOP under control). RESULTS Among the 106 eyes (77 patients) included were 54 MCT and 52 CAS eyes. At last visit, after a single surgery, qualified success was 85% (46 eyes) in MCT and 37% (19 eyes) in CAS. Complete success was 69% (37 cases) in MCT and 23% (12 cases) in CAS. The mean (95% confidence interval) change in axial length after surgery was -0.03 mm (-0.34 to 0.40) for MCT and +1.35 mm (-0.64 to 1.62) for CAS (P < .001). The percentage of IOP reduction was 52.1% in MCT and 45.5% in CAS (P = .1616). Further glaucoma surgery was required in 5.5% (3) in MCT and 63.4% (33) in CAS. At 1 year, 94.3% of MCT cases achieved qualified success compared to 34.6% of CAS (P < .0001). No significant complications were found on either group. CONCLUSION MCT achieved better results with significantly lower reoperation rates. The transition from CAS to MCT can be easily achieved, even in difficult cases or those previously operated.
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Chan JCH, Chow SC, Lai JSM. Retrospective analysis of paediatric glaucoma at a tertiary referral centre in Hong Kong. Jpn J Ophthalmol 2020; 65:115-121. [PMID: 33104957 DOI: 10.1007/s10384-020-00779-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the epidemiological features, clinical interventions, and outcomes of paediatric glaucoma in Hong Kong. STUDY DESIGN Retrospective chart review. METHODS Clinical data from the medical records of all patients under 18 years of age diagnosed with glaucoma from January 2008 to December 2017 at a university-affiliated, tertiary referral centre were collected. The patients' demographics, etiological distribution, clinical interventions, and outcomes were analysed. RESULTS A total of 33 subjects (53 eyes) were identified, 30 (49 eyes) of whom were Chinese. Primary glaucoma accounted for 21.2% of subjects, while 78.8% were diagnosed with secondary glaucoma. The most common subtype was juvenile-onset open angle glaucoma, followed by Sturge-Weber Syndrome related glaucoma. The most commonly performed surgical interventions were tube-shunt surgery (Ahmed Glaucoma Valve) and transscleral cyclophotocoagulation. Most eyes had significant reduction in intraocular pressure after medical or surgical intervention, but deterioration of visual acuity remained common. CONCLUSION Most cases of childhood glaucoma in Hong Kong are secondary rather than primary, similar to other regions with low incidence of parental consanguinity. The large proportion of secondary glaucoma which generally has poorer prognosis, is reflected by the frequency of multiple surgery, and a high incidence of visual deterioration despite significant intraocular pressure reduction in most eyes.
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Affiliation(s)
- Jonathan Cheuk-Hung Chan
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, People's Republic of China.
| | - Shing Chuen Chow
- LKS Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - Jimmy Shiu-Ming Lai
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, People's Republic of China
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Kuhli-Hattenbach C, Fronius M, Kohnen T. [Timing of congenital cataract surgery : Amblyopia versus aphakic glaucoma]. Ophthalmologe 2020; 117:190-198. [PMID: 32076840 DOI: 10.1007/s00347-020-01053-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A congenital cataract is a rare disorder, which is associated with a high risk of amblyopia. Ophthalmologists are faced with many diagnostic and surgical challenges in the management of this disease. Older children can undergo primary treatment with an intraocular lens, whereas children younger than 12 months of age usually initially remain aphakic. The most frequent long-term complication of aphakic eyes following congenital cataract surgery in connection with posterior capsulorrhexis and anterior vitrectomy is aphakic glaucoma, which in individual cases can lead to substantial impairment of vision. Many factors have been reported to increase the risk of postoperative glaucoma, including microphthalmos, fetal nuclear cataract, conspicuous family history and associated ocular malformations, such as persistent fetal vasculature (PFV). Cataract surgery during early infancy is well-established to be the most important factor for the formation of postoperative aphakic glaucoma. In individual treatment planning it has to be considered that although younger age at the time of cataract removal can provide better prerequisites for prophylaxis of amblyopia, it also confers a higher risk of development of aphakic glaucoma. Children undergoing congenital cataract surgery have to be regularly monitored given the lifelong risk for postoperative complications, such as aphakic glaucoma.
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Affiliation(s)
- C Kuhli-Hattenbach
- Klinik für Augenheilkunde, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - M Fronius
- Klinik für Augenheilkunde, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - T Kohnen
- Klinik für Augenheilkunde, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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Abstract
PURPOSE OF REVIEW The management of pediatric glaucoma poses a unique challenge in terms of maintaining lifelong vision and combating an aggressive scarring response from surgery. Contemporary literature regarding the surgical management of children with pediatric glaucoma who fail, or are at a high risk of failure, from conventional surgery is limited. The aim of this review is to highlight recent developments in relation to the current opinion regarding the management of children with refractory pediatric glaucoma. RECENT FINDINGS Some studies have reported impressive success rates with circumferential trabeculotomy, even in eyes with previous failed surgery. Early results of deep sclerectomy in populations which may not respond well to conventional angle surgery are encouraging but data is limited for the pediatric age group. In compliant patients in whom multiple postoperative examinations under anesthesia are possible, trabeculectomy remains an effective procedure. Multiple recent studies have demonstrated that glaucoma drainage device (GDD) surgery is associated with 5-year success rates of over 70% in primary childhood glaucomas. SUMMARY Glaucoma drainage device surgery is likely to remain a mainstay of surgical management for refractory glaucoma in older children. More prospective data are needed on the success of circumferential trabeculotomy, deep sclerectomy and micropulse laser in pediatric eyes with previous failed surgery. VIDEO ABSTRACT: http://links.lww.com/COOP/A34.
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