Angle Surgery in Pediatric Glaucoma Following Cataract Surgery

Abstract

Glaucoma is a common and sight-threatening complication of pediatric cataract surgery Reported incidence varies due to variability in study designs and length of follow-up. Consistent and replicable risk factors for developing glaucoma following cataract surgery (GFCS) are early age at the time of surgery, microcornea, and additional surgical interventions. The exact mechanism for GFCS has yet to be completely elucidated. While medical therapy is the first line for treatment of GFCS, many eyes require surgical intervention, with various surgical modalities each posing a unique host of risks and benefits. Angle surgical techniques include goniotomy and trabeculotomy, with trabeculotomy demonstrating increased success over goniotomy as an initial procedure in pediatric eyes with GFCS given the success demonstrated throughout the literature in reducing IOP and number of IOP-lowering medications required post-operatively. The advent of microcatheter facilitated circumferential trabeculotomies lead to increased success compared to traditional <180° rigid probe trabeculotomy in GFCS. The advent of two-site rigid-probe trabeculotomy indicated that similar results could be attained without the use of the more expensive microcatheter system. Further studies of larger scale, with increased follow-up, and utilizing randomization would be beneficial in determining optimum surgical management of pediatric GFCS.

Outcomes of Goniotomy With or Without Secondary Intraocular Lens Implantation in Pediatric Glaucoma Following Cataract Surgery: A Prospective Pilot Study

“…GT is a classic angle surgery that demonstrated success in the management of congenital glaucoma with a success rate, defined by adequate IOP control without topical ocular hypotensive therapy, of up to 80% 5,25 . Nevertheless, the data on GT in the management of GFCS are limited in the literature.…”

“…Angle surgery, such as goniotomy (GT), has conventionally been utilized as the first-line procedure in GFCS to obviate the need for more invasive surgical procedures that are associated with significant complications and a worse prognosis 5 . GT is performed to incise the trabecular meshwork (TM) and the inner wall of the Schlemm’s canal to facilitate aqueous drainage, which reduces outflow resistance and lowers IOP 6,7 .…”

“…3 Angle surgery, such as goniotomy (GT), has conventionally been utilized as the first-line procedure in GFCS to obviate the need for more invasive surgical procedures that are associated with significant complications and a worse prognosis. 5 GT is performed to incise the trabecular meshwork (TM) and the inner wall of the Schlemm's canal to facilitate aqueous drainage, which reduces outflow resistance and lowers IOP. 6,7 Meanwhile, secondary intraocular lens (IOL) implantation is a beneficial and common method in the optical rehabilitation of children who are left aphakic after cataract extraction, 8 and is commonly performed in congenital cataract patients older than 2 years old.…”

Approach to childhood glaucoma: A review

“…When medical therapy fails surgical intervention is indicated but there is no consensus on preferred approach. 72,84,85 (Figure 3E) Although angle surgery has been reported in this cohort, the success rate is limited. Trabeculectomy may be considered in older more co-operative children though the risk of failure increases with aphakia.…”

Slow-Coagulation Transscleral Cyclophotocoagulation Laser Treatment for Medically Uncontrolled Secondary Aphakic Adult Glaucoma

“…6,7 Recent literature mainly focuses on pediatric glaucoma following cataract surgery, whereas adult literature is scarce and outdated. [8][9][10][11][12] Management of adult aphakic glaucoma is challenging, with limited success of trabeculectomy and glaucoma drainage device (GDD) implantation in aphakic patients possibly due to associated inflammation, scarred or damaged conjunctiva, scarring of trabeculectomy ostium or occlusion of GDD by vitreous, and the higher risk of hypotony in these cases. 13,14 Continuous wave transscleral cyclophotocoagulation (CW-TSCPC) laser is used for the surgical management of glaucoma.…”