Surgical Outcomes In Children With Primary Childhood Glaucoma

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Presentation transcript:

Surgical Outcomes In Children With Primary Childhood Glaucoma Suzan Guven Yılmaz, Bilge Yıldırım, Halil Ates Ege University Hospital, Ophthalmology Department INTRODUCTION Surgical treatment is usually the primary approach for childhood glaucoma. Classical initial surgery is goniotomy or trabeculectomy. 1,2 When the IOP is not controlled after the first surgery, the surgical options are filtration surgery with anti-fibrosis drugs, glaucoma drainage implants or cyclodestructive procedures. Repeat surgery is relatively frequent. 3 PURPOSE To evaluate outcomes of surgical treatment in children with primary childhood glaucoma. MATERIAL and METHOD The medical records of 91 eyes of 52 patients with primary childhood glaucoma who underwent glaucoma surgery at university clinic between 2001 and 2016, were reviewed. Trabeculotomy was prefered as initial procedure. Trabeculectomy (with mitomycin-C), tube shunt (Ahmed valve) and cyclodestructive (endoscopic cyclophotocoagulation) procedures were performed as a next surgeries. Success was defined as postoperative intraocular pressure (IOP) ≤21 mmHg with or without medication. Success rates, IOP, subsequent interventions and and ocular comorbidity were determined during follow-up and at the final visit. RESULTS The mean age of 52 patients (29 male, 23 female) at the surgery was 14.8±31.7 (1day-168 months) months. The diagnosis was primary congenital glaucoma (<2 months) in 26 (50%) eyes, infantile glaucoma (2months-2 years) in 18 (34.6%) eyes, and juvenil glaucoma (>2 years) in 8 (15.4%) eyes. The mean follow-up was 60.58 ± 43.95 (6-240) months. The mean IOP decreased from 30.9±6.7 (21-54) mmHg to 17.4 ± 6.8 (5-28) mmHg at the last follow-up (p<0.05). Surgical success was achieved in 70 (76.9%) eyes after a mean number of operation/eye of 1.9±1.3 (1-7). The postoperative complications included hyphema (5 eyes), choroidal detachment (3 eyes), shunt extrusion (3 eyes), retina detachment (1 eye) and endophthalmitis (2 eyes). Table 2 - Clinical characteristics of patients with primary childhood glaucoma. Table 1-Type and Number of Surgery. DISCUSSION The treatment of pediatric glaucoma cases is particulary challenging due to the nature of the disease and to the inttrinsic difficulties in operating them.4 Initial surgery is indicated in nearly all cases with primary childhood glaucoma. Surgical treatments can usually achieve safe and effective results with congenital glaucoma if performed promptly and appropriately. 5-7 Whenever possible these cases should be referred to tertiary care centers. In conclusion glaucoma surgery is essential treatment with good success in primary childhood glaucoma. However, because of high risk of postoperative complications close follow up is required. REFERANCES 1.Papadopoulos M, Khaw PT. Advances in the management of paediatric glaucoma. Eye (Lond) 2007;21(10):1319-25. 2.Mandal AK, Chakrabarti D. Update on congenital glaucoma. Indian J Ophthalmol. 2011;59:148-57. 3.Alsheikheh A, Klink J, Klink T, et al. Long-term results of surgery in childhood glaucoma. Graefes Arch Clin Exp Ophthalmol 2007;245(2):195-203. 4. Grehn F. Congenital glaucoma surgery: a neglected field in ophthalmology? Br J Ophthalmol 2008:92(1):1-2. 5.Meyer G, Schwenn O, Pfeiffer N, Grehn F. Trabeculectomy in congenital glaucoma. Graefes Arch Clin Exp Ophthalmol 2000;238(3):207-13. 6. Fieß A, Furahini G, Bowman R, Bauer J, Dithmar S, Philippin H. Outcomes of surgical interventions for primary childhood glaucoma in Northern Tanzania. Br J Ophthalmol. 2016 Apr 20. pii: bjophthalmol-2015-308137. doi: 10.1136/bjophthalmol-2015- 308137. 7 Yassin SA, Al-Tamimi ER. Surgical outcomes in children with primary congenital glaucoma: a 20-year experience. Eur J Ophthalmol. 2016 Nov 4;26(6):581-7.