Surgical interventions for primary congenital glaucoma

Ghate, Deepta; Wang, Xue

doi:10.1002/14651858.cd008213.pub2

Cited by 29 publications

(14 citation statements)

References 67 publications

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“…These results were comparable to many of previous studies. 17,18 In present study 24 (60%) were males while 16 (40%) were females. 30 (75%) patients were ages ≤2 years and 10 (25%) patients had ages >2 years.…”

Section: Discussionsupporting

confidence: 45%

Mean Change in Intra-Ocular Pressure in patients undergoing Trabeculectomy with Mitomycin C

Rehman¹,

Dayal²,

Abidin³

2021

PJMHS

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Aim: To examine the outcomes of trabeculectomy followed by mitomycin C in term of mean change in intra-ocular pressure in patients presented with primary congenital glaucoma. Study design: Cross-sectional/observational Place and duration of study: Department of Ophthalmology, Khawaja Muhammad Safdar Medical College, Allama Iqbal Memorial Teaching Hospital, Sialkot from 7th July 2020 to 6thJanuary 2021. Methods: Fortypatients of both genders with ages up to 5 years presented with primary congenital glaucoma were enrolled in this study. Patients demographics were recorded after taking written consent from parents/guardians. All the patients were receivedtrabeculectomy with 0.4mg/ml Mitomycin C was applied below the flap for 2 to 3 minutes. Intraocular pressure was examined preoperatively and at 12th day after surgery. Results:Twenty-four (60%) were males while 16 (40%) were females. 30 (75%) patients were ages <2yearsand 10 (25%) patients had ages >2 years. A significant difference was observed regarding mean change in intra-ocular pressure (pre-operatively 30.48±3.62 versus post-operatively 16.35±2.86) with p-value <0.001. Conclusion: Trabeculectomy with Mitomycin C is very effective for reducing intraocular pressure. A significant decrease in intra-ocular pressure was observed post-operatively. Keywords: Primary congenital glaucoma, Intra-ocular pressure, Trabeculectomy, Mitomycin C

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Section: Discussionsupporting

confidence: 45%

Mean Change in Intra-Ocular Pressure in patients undergoing Trabeculectomy with Mitomycin C

Rehman¹,

Dayal²,

Abidin³

2021

PJMHS

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“…It is widely debated which primary surgical method is to be preferred in patients with PCG. In the World Glaucoma Association consensus Series 9 (Childhood Glaucoma), the general consensus was, that 'angle surgery (goniotomy and trabeculotomyconventional or circumferential) is the procedure of choice for PCG' and in a Cochrane Review (Ghate & Wang 2015) it was found (with a limited amount of datasets) that no significant difference was found between several IOP lowering procedures for PCG. A later randomized study comparing primary trabeculotomy to combined trabeculectomy/trabeculotomy did not find any difference in the success rates either (Khalil & Abdelhakim 2016).…”

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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“…[ 3 ] Children diagnosed with congenital glaucoma having glaucomatous optic neuropathy should probably have their IOPs reduced to at least such levels, to optimize function of their already damaged optic nerves. A Cochrane review on surgery for Primary congenital glaucoma[ 4 ] found common success criteria ranging from <22 or <21 mm Hg, with few looking at success of <15 mm Hg or <12 mm Hg. [7–10] Our study has evaluated Primary congenital glaucoma eyes for preoperative and postoperative clinical features over more than 2 years after surgery leading to better optic nerve head status and lower refractive errors.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have reported surgical success in primary congenital glaucoma as an IOP <21 mm Hg or <18 mm Hg, with recent work looking at a target IOP of <15 mm Hg. [ 4 5 ] However, most studies have reported primary outcomes of IOP alone, with only a few reporting resulting optic nerve head status and refraction. It would be important to see at what IOP, optic nerve head reversal/stability takes place, and corneal and ocular enlargement is halted or reduced to physiological limits.…”

mentioning

confidence: 99%

Evaluating target intraocular pressures in primary congenital glaucoma

Sihota

Sidhu

Agarwal

et al. 2021

Indian Journal of Ophthalmology

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Purpose: The aim of this study was to evaluate long-term intraocular pressures that provide stabilization/reversal of glaucomatous neuropathy after surgery in primary congenital glaucoma (PCG). Methods: Prospective evaluation of consecutive PCG patients who underwent trabeculectomy-trabeculotomy and followed up for ≥2 years. Records of regularly performed examination under anesthesia were maintained to ascertain intraocular pressure, (IOP), fundus, refraction and corneal diameter. Outcomes – Primary: cup: disc ratio and intraocular pressure, Secondary: corneal changes and refractive error Results: A total of 174 eyes of 108 children with PCG had a preoperative IOP of 22.44 ± 9.5 mm Hg. Postoperative review IOP was 11.8 ± 4.5 mm Hg, cup-disc-ratio was 0.52 ± 0.23 and corneal diameter was 12.75 ± 0.9 mm. Primary outcomes: Linear regression analysis showed a significant positive correlation of review IOP with cup disc ratio, P = 0.004. 67.9%, of eyes at a review IOP range of 6-12 mm Hg showed reversal, 14.1%, were stable, at 6-15 mm Hg, while 3.84% showed an increase in cup: disc ratio 16-22 mm Hg. Patients operated before 6 months of age had a significantly smaller final cup-disc ratio, P = 0.0013. Patients with a final cup: disc ratio of >0.9 were significantly older at surgery, P < 0.001. Secondary outcomes: There was a positive correlation of final myopia with review IOP on linear regression analysis, P = 0.012. The final spherical error in eyes having cup disc ratio of ≤ 0.5 was –0.96 ± 4.5 diopters, as against -3.45 ± 7.7 diopters in eyes having cup-disc ratio of 0.6-0.8 and -3.8 ± 6.9 diopters in eyes with cup disc ratio of ≥0.9, P = 0.015. There was no significant change in corneal diameter. Conclusion: Patients operated after 6 months of age had a larger final cup: disc ratio, while postoperative review intraocular pressures over 2 years of at least ≤15 mm Hg in primary congenital glaucoma eyes, commonly lead to reversal/stability of the neuropathy, and a lower incidence and degree of myopia.

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Surgical interventions for primary congenital glaucoma

Cited by 29 publications

References 67 publications

Mean Change in Intra-Ocular Pressure in patients undergoing Trabeculectomy with Mitomycin C

Mean Change in Intra-Ocular Pressure in patients undergoing Trabeculectomy with Mitomycin C

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

Evaluating target intraocular pressures in primary congenital glaucoma

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