Macular and peripapillary vascular parameters in the fellow eyes of unilateral primary congenital glaucoma: a comparative study

PURPOSE

To study the fellow eyes of patients with unilateral primary congenital glaucoma (PCG) using optical coherence tomography angiography (OCTA) and compare them to normal age- and refractive error-matched healthy controls.

METHODS

Using OCTA, the foveal avascular zone (FAZ) area, cup:disk ratio, vessel density (VD) of the optic nerve head (ONH) and peripapillary area and the macular VD in superficial (SCP) and deep vascular complexes in both 3 mm and 6 mm scans of both groups were compared. Clinical data included best-corrected visual acuity (BCVA), cycloplegic refraction, intraocular pressure (IOP), anterior and posterior segments examination findings, including ONH cup:disk ratio.

RESULTS

A total of 48 eyes of 48 children (24 eyes in each group) were included. There was no difference in the mean retinal nerve fiber layer thickness, cup:disk ratio, baseline visual acuity, or spherical equivalent between groups (P > 0.05). In the 3 mm macular scan, the VD of the SCP at the fovea was significantly higher in the PCG group compared to controls (P = 0.04). In the ONH scans, there was a significantly reduced inside the disk VD in the PCG group compared to controls (P = 0.03). There was no significant difference in other macular and ONH vascular parameters between groups (P > 0.05).

CONCLUSIONS

In our study cohort, there was no difference in most of the macular and ONH vascular parameters between groups. However, the fellow eyes of PCG patients exhibited higher VD of the SCP at the fovea and reduced inside the disk VD compared with control eyes.

Gonioscopy-Assisted Transluminal Trabeculotomy following Failed Glaucoma Surgery in Primary Congenital Glaucoma: One-Year Results

Purpose

To evaluate the one-year outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in primary congenital glaucoma (PCG) with a history of prior glaucoma surgery.

Methods

A retrospective chart review was performed to identify all PCG patients ≤ 16 years who underwent GATT surgery at Cairo University Children's Hospital from January 2016 to March 2022. Pre- and postoperative intraocular pressure (IOP) and glaucoma medications were collected at 1, 3, 6, 9, 12, and last follow-up visits. Success was defined as IOP ≤ 21 mmHg without (complete) or with (qualified) glaucoma medications at the last follow-up.

Results

Seven eyes of 6 subjects were included in the study. The mean IOP was statistically significantly reduced from 25.7 ± 5.9 mmHg preoperatively to a mean IOP of 12 ± 1.5 mmHg (P = 0.001) at 12 months and 11.5 ± 1.2 mmHg (P = 0.001) at the last follow-up visit. Six eyes (85.7%) achieved complete success, and one eye (14.2%) achieved qualified success. No patients required further glaucoma procedures. No serious intra- or postoperative complications were identified.

Conclusions

Our early experience highlights that GATT can be performed as an alternative procedure before considering conjunctival or scleral glaucoma surgeries.

Childhood glaucoma profile in a tertiary centre in Egypt according to the childhood glaucoma research network classification

PURPOSE

To describe the prevalence and clinical characteristics of a large cohort of childhood glaucoma patients that presented to a tertiary Egyptian children's hospital using the childhood glaucoma research network (CGRN) classification.

METHODS

A retrospective review of the medical records of all patients ≤ 14 years with a diagnosis of childhood glaucoma or glaucoma suspects who presented to Children's Hospital between January 2014 to December 2019 was conducted. Data collected included age at the time of diagnosis, gender, laterality, prenatal history, parental history, including consanguinity, intraocular pressure, horizontal corneal diameter, and cup-to-disc ratio.

RESULTS

A total of 1113 eyes of 652 patients with diagnoses of either childhood glaucoma or glaucoma suspects were included in the study. Six hundred and sixteen patients (94%) were born full-term. A history of positive parental consanguinity was identified in 334 patients (51.2%). Almost 60% of patients were males. Primary congenital glaucoma (PCG) was the most prevalent diagnosis (68.2%), followed by glaucoma suspects (10.4%) and glaucoma following cataract surgery (GFCS) (8.4%). Juvenile open-angle glaucoma was the least prevalent category (0.3%). Other categories including glaucoma associated with non-acquired systemic disease, glaucoma associated with non-acquired ocular disease, and glaucoma associated with acquired conditions represented 5.8%, 4.7%, and 1.9%, respectively.

CONCLUSIONS

PCG is the most common form of glaucoma in Egypt. More than half of the pediatric glaucoma patients had a positive history of parents' consanguinity.

Kahook Dual Blade Ab-interno Trabeculectomy Compared With Conventional Goniotomy in the Treatment of Primary Congenital Glaucoma: 1-Year Results

INTRODUCTION

Kahook dual blade (KDB) removes a strip of the trabecular meshwork from the angle, which may make it superior to simple goniotomy in treating the angle anomaly in primary congenital glaucoma (PCG). This prospective study compares KDB ab-interno trabeculectomy to conventional goniotomy in PCG.

METHODS

Forty-two eyes of 29 patients with PCG underwent ab-interno trabeculectomy using a KDB or conventional goniotomy using a 25-G irrigating needle, targeting 100 to 120 degrees of the nasal iridocorneal angle. Patients were seen at 1, 3, 6, and 12 months postoperatively. Success was defined as intraocular pressure (IOP) ≤21 mm Hg at 1-year follow-up visit, with no evidence of glaucoma progression.

RESULTS

The KDB group included 21 eyes of patients with a median age of 6 months (interquartile range: 4 to 8.5 mo) and the goniotomy group included 21 eyes of patients with a median age of 5 months (interquartile range: 3 to 9.5 mo). There was a significant reduction in IOP in both groups at all follow-up visits. The reduction in the number of glaucoma medications was significant at 1, 3, and 6 months postoperatively in the KDB group, and at 1 month in the goniotomy group. There was no significant difference in IOP or glaucoma medications between both groups at any follow-up visit. Success was achieved in 12 eyes (57.1%) in each group, with no eyes developing any serious complications.

CONCLUSION

One-year results show that KDB ab-interno trabeculectomy is at least as effective as goniotomy in the treatment of PCG. Eyes with bilateral glaucoma had a tendency to fail both procedures.

One-year results of two-site trabeculotomy in paediatric glaucoma following cataract surgery

PURPOSE

The management of glaucoma following cataract surgery (GFCS) in children is challenging. This study looks at the results of two-site trabeculotomy in paediatric aphakic/pseudophakic glaucoma, 1-year post operatively.

METHODS

This prospective, institutional study was performed on 33 eyes with GFCS in patients aged ≤14 years. Patients underwent two-site trabeculotomy using the rigid-probe trabeculotome, through a superonasal and an inferotemporal scleral flap. Intraocular pressure (IOP), medications, complications and success rates at 1 year were reported. Success was defined as IOP < 23 mmHg or 30% IOP reduction, on the same or fewer number of medications at 1 year, without the need for another glaucoma procedure.

RESULTS

Trabeculotomy was performed on average 3.5 years after the cataract surgery. Patients were aged 5.73 ± 1.79 years. We excluded four eyes in which >180° incision could not be achieved. A 360° incision was achieved in 14 eyes (48%). There was a significant reduction in IOP and medications at 1, 3, 6 and 12 months (p < 0.001). At 1 year, mean IOP reduction was 48.2 ± 31.5%. Success was achieved in 26 eyes (89.6%), of which 15 were controlled without medications. There was no significant difference in IOP, medications or success between aphakic and pseudophakic eyes nor between eyes that had 360° trabeculotomy and eyes that had a 180-270° incision. Three eyes (10.3%) required another glaucoma procedure. One eye required core vitrectomy for vitreous haemorrhage.

CONCLUSIONS

Two-site trabeculotomy can be used as an effective and safe first-line procedure in paediatric GFCS eyes that do not have extensive peripheral anterior synechiae.

Incidence and Risk Factors of Early-onset Glaucoma following Pediatric Cataract Surgery in Egyptian Children: One-year Study

Aim

To study the incidence and risk factors of glaucoma occurring within 1 year following pediatric cataract surgery in Egyptian children.

Materials and methods

This is a prospective nonrandomized study conducted at Aburich Children’s Hospital, over a period of 1 year on a cohort of Egyptian patients with congenital and infantile cataract. One hundred and fifty eyes of 88 patients were enrolled in this study. All the patients underwent anterior approach removal of lens matter, whereas primary intraocular lens (IOL) implantation was carried at the age of 1 and 2 years for unilateral and bilateral cases respectively. Intraocular pressure (IOP) was measured at 1 week, 1 month, 3 months, 6 months, 9 months, and 1 year. For those who developed glaucoma, time of diagnosis and associated risk factors were reported.

Results

The incidence of glaucoma was 11.33% (17 of 150 eyes), while incidence of glaucoma suspect was 0.67% (1 of 150 eyes) in the first year following cataract surgery. The majority of the cases (66.7%) were discovered in the first 3 months postcataract surgery. Age at time of cataract surgery, the state of aphakia/pseudophakia, persistent fetal vasculature (PFV), and microphthalmia were not found to be significant predictors of early-onset glaucoma in our study.

Conclusion

Aphakic glaucoma continues to be a devastating condition with high incidence during first year following cataract surgery.

Clinical significance

Regular follow-up should start as early as possible following cataract surgery. Further prospective studies with larger study population are required.

How to cite this article: Gawdat GI, Youssef MM, Bahgat NM, Elfayoumi DM, Eddin MAS. Incidence and Risk Factors of Early-onset Glaucoma following Pediatric Cataract Surgery in Egyptian Children: One-year Study. J Curr Glaucoma Pract 2017;11(3):80-85.

Evaluation of Artisan aphakic intraocular lens in cases of pediatric aphakia with insufficient capsular support

PURPOSE

To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support.

METHODS

In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients >2 years of age with insufficient capsular support who underwent Artisan intraocular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth <3 mm, central endothelial cell density (CECD) <2500 cells/mm(²), uncontrolled glaucoma, or uveitis were excluded. Best-corrected visual acuity, intraocular pressure (IOP), and CECD were measured at 1, 6, and 12 months postoperatively.

RESULTS

A total of 25 aphakic eyes of 18 patients (mean age, 7.86 ± 3.08 years) with insufficient capsular support for a standard posterior chamber IOL were included, 18 eyes with subluxated lens and 7 following trauma. The mean preoperative logMAR best-corrected visual acuity for traumatic aphakic patients was 0.95 ± 0.36; for patients with subluxation, 0.7 ± 0.26. Values improved at 1 year to 0.38 ± 0.15 (P < 0.002) and 0.3 ± 0.2 (P < 0.0001), respectively. One year after surgery the CECD (2892.64 ± 441.79 cells/mm(²)) was significantly reduced from the preoperative and 1 month postoperative values (3573.36 ± 468.9 cells/mm(2), 3081 ± 495 cells/mm(²); P < 0.0001, P < 0.02 resp.). Two cases (8%) developed traumatic dislocation. Pupillary block occurred in 1 case (4%).

CONCLUSIONS

Artisan IOL implantation for pediatric aphakia achieved a good visual outcome.

Severe fibrosis of extraocular muscles after the use of lyophilized amniotic membrane in strabismus surgery

Various techniques have been used to reduce adhesions after strabismus surgery. Wrapping the extraocular muscles with cryopreserved amniotic membrane has been reported to yield good results. In the case reported here, we used lyophilized amniotic membrane to wrap the extraocular muscles. Extensive adhesions developed, and inelastic, fibrotic muscles were discovered at a subsequent operation.