Factors associated with early and late failure after goniotomy for primary pediatric glaucoma

Hassanein, Dina H.; Awadein, Ahmed; Elhilali, Hala

doi:10.1177/1120672118805872

Cited by 15 publications

(18 citation statements)

References 23 publications

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“…Moreover, in the present study, the operated eyes also had more severe glaucoma. Indeed, the initial mean IOP was 30.11 ± 7.08 mm Hg compared to 22 ± 4.5 mm Hg for Durr et al and 24.8 ± 3.86 mm Hg in the study by Quaranta et al It has been shown that higher pre-operative IOP can be a risk factor for failure of filtering surgery [ 16 , 17 , 18 ]. Our study found a success rate of 24% in patients who received needling or bubble filtration.…”

Section: Discussionmentioning

confidence: 98%

Safety and Efficacy of the Preserflo® Microshunt in Refractory Glaucoma: A One-Year Study

Majoulet

Scemla

Hamard

et al. 2022

JCM

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Purpose: To evaluate the safety and efficacy of Preserflo® microshunt implantation in eyes with refractory glaucoma. Methods: In this retrospective study, a cohort of patients who underwent Preserflo® microshunt implantation between April 2019 and August 2020 for refractory glaucoma were evaluated. At the time of surgery, all eyes had uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy and at least one previous failed glaucoma filtering surgery. The primary outcome was a complete success, defined as postoperative IOP ≤ 21 mm Hg with an IOP reduction ≥ 20% and no repeat filtering surgery. The secondary outcome was qualified success, defined as a complete success with the use of antiglaucoma medications. The rates of needling, bleb repair, and postoperative complications were also recorded. Results: Forty-seven eyes with a mean preoperative IOP of 30.1 ± 7.1 mm Hg and a mean of 3.4 ± 1 glaucoma medications were included. The mean number of previous surgeries prior to microshunt implantation was 2.3 ± 1.3. After 1 year, the mean IOP was significantly reduced to 18.8 ± 4.6 mm Hg, with the mean number of medications significantly reduced to 1.4 ± 1.2. Complete success was achieved in 35% of eyes, and a qualified success in 60% of eyes. A decrease in IOP of at least 30% was found in 55% of eyes. Needling or bleb repair was performed in 49% of eyes. Complications were minimal and transient, except for one eye which presented with tube extrusion, and another eye with a transected tube. A repeat glaucoma surgery had to be performed in 17% of eyes. Conclusions: The Preserflo® Microshunt provided moderate success but a significant reduction in IOP, with a good safety profile after one year of follow-up in eyes at high risk for failure of filtering surgery.

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Section: Discussionmentioning

confidence: 98%

Safety and Efficacy of the Preserflo® Microshunt in Refractory Glaucoma: A One-Year Study

Majoulet

Scemla

Hamard

et al. 2022

JCM

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“…We found a tendency towards greater risk of requiring more than one glaucoma procedure to control IOP in children operated before 3 months of age and in boys. Others have found that more severely affected children have an increased risk of failure (Al‐Hazmi et al 2005) and that boys are at greater risk of failure than girls (Hassanein et al 2018). The prevalence of PCG has been reported to be higher in boys by many studies (McGinnity et al 1987; de Silva et al 2011; Suri et al 2015) including in our population (Pedersen et al 2019).…”

Section: Discussionmentioning

confidence: 99%

Long‐term success after trabeculotomy in primary congenital glaucoma – a study with up to 35 years follow‐up

Kessel

Pedersen

Siersma

et al. 2020

Acta Ophthalmologica

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Purpose To evaluate the surgical success after trabeculotomy for primary congenital glaucoma (PCG) in Denmark in the last 40 years. Methods Retrospective review of medical files on children who all underwent trabeculotomy as the first surgical intervention between January 1rst, 1977 and December 31, 2016. Information on diagnosis and surgical procedures were extracted. Primary outcome was surgical success was defined as intraocular pressure (IOP) < 21 mmHg without medications one year after surgery. Secondary outcome was the number of reoperations needed. Results Out of 118 children with PCG, 96 children (144 eyes) had an ab externo trabeculotomy as primary IOP lowering procedure opening Schlemm’s channel 4 clock hours into the anterior chamber. Complete surgical success at one year was achieved in 73% (106 of 144 eyes). On the long term, IOP could be controlled by one surgical procedure in 2/3 of children, eight eyes required >5 surgical procedures to control IOP. In 12.1% of children the second glaucoma procedure was performed >5 years after the initial trabeculotomy. There was a tendency towards greater risk of needing a second procedure in patients < 3 months of age at primary trabeculotomy (hazard ratio, HR, 2.01, 95% CI 0.96–4.22) and in boys (HR 2.02, 95% CI 0.97–4.18) and a lower risk of requiring a third surgery if the second surgery was trabeculectomy with MMC. Conclusion Dedicated follow‐up of patients with PCG is essential as the disease may continue to progress even after years of quiescence and some children need multiple surgeries to control IOP. Additional glaucoma procedures are required in 1/3 of children and boys and younger patients seem to be at greater risk.

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“…1,3,5,9,10,11,12,13 In addition, these angle procedures appear to have better outcomes in patients with PCG presenting between 1-24 months of age and have a worse prognosis in neonatal-onset PCG and in those with late-onset disease. 10,43,44…”

Section: Angiopoietin Receptor Tyrosine Endothelial Cell Kinase (Tek)mentioning

confidence: 99%

Update in Genetics and Surgical Management of Primary Congenital Glaucoma

Mocan¹,

Mehta²,

Aref³

2019

tjo

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Primary congenital glaucoma (PCG) continues to be an important cause of visual impairment in children despite advances in medical and surgical treatment options. The progressive and blinding nature of the disease, together with the long lifespan of the affected population, necessitates a thorough understanding of the pathophysiology of PCG and the development of long-lasting treatment options. The first part of this review discusses the genetic features and makeup of this disorder, including all currently identified genetic loci (GLC3A, GLC3B, GLC3C and GLC3D) and relevant protein targets important for trabecular and Schlemm canal dysgenesis. These target molecules primarily include CYP1B1, LTBP2, and TEK/Tie2 proteins. Their potential roles in PCG pathogenesis are discussed with the purpose of bringing the readers up to date on the molecular genetics aspect of this disorder. Special emphasis is placed on functional implications of reported genetic mutations in the setting of PCG. The second part of the review focuses on various modifications and refinements to the traditional surgical approaches performed to treat PCG, including advances in goniotomy and trabeculotomy ab externo techniques, glaucoma drainage implant surgery and cyclodiode photocoagulation techniques that ultimately provide safer surgical approaches and more effective intraocular pressure control in the 21 st century.

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Factors associated with early and late failure after goniotomy for primary pediatric glaucoma

Cited by 15 publications

References 23 publications

Safety and Efficacy of the Preserflo® Microshunt in Refractory Glaucoma: A One-Year Study

Safety and Efficacy of the Preserflo® Microshunt in Refractory Glaucoma: A One-Year Study

Long‐term success after trabeculotomy in primary congenital glaucoma – a study with up to 35 years follow‐up

Update in Genetics and Surgical Management of Primary Congenital Glaucoma

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