Childhood Glaucoma Surgery in Developing Countries

Mandal, Anil K.; Senthil, Sirisha

doi:10.1007/978-3-319-54003-0_11

Cited by 6 publications

(3 citation statements)

References 59 publications

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“…However, there is controversy in the literature regarding the initial surgical procedure of choice in the treatment of PCG of the developing world (Beck 2011; Moore et al. 2013; Smandal & Senthil 2018). Angle incision surgery has traditionally been regarded as the procedure of choice in the Western populations (deLuise & Anderson 1983).…”

Section: Introductionmentioning

confidence: 99%

Combined trabeculotomy−trabeculectomy for primary congenital glaucoma: long‐term experience from a tertiary referral centre in a developing nation

Mandal

Gothwal

Khanna

2021

Acta Ophthalmologica

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Purpose: To evaluate the long-term visual and surgical outcomes, and associated risk factors for poor outcomes in patients with primary congenital glaucoma (PCG). Methods: Retrospective review of medical records of children who underwent combined trabeculotomyÀtrabeculectomy (CTT) without mitomycin-C as the first surgical procedure by a single surgeon between January 1990 and December 2010. Success was defined as intraocular pressure (IOP) <16 mmHg without (complete) or with (qualified) one glaucoma medication. We used the WHO criteria of vision loss to categorize the levels of vision impairment (VI). For purposes of statistical analysis, we randomly chose one eye of patients for bilateral PCG and affected eye in unilateral PCG. Results: The cohort included 653 consecutive PCG patients (1128 eyes; mean age, 26 months), of whom 475 (73%) underwent simultaneous bilateral CTT. Kaplan-Meier survival analysis revealed 1-, 5-, 10-, 15-, and 19-year complete success rates of 92.6% (n = 372), 75.5% (n = 173), 55.9% (n = 72), 44.7% (n = 19), and 21.6% (n = 3), respectively. Multivariate analysis revealed independent associations between failure, preoperative corneal clarity, and prior glaucoma surgery. Mean follow-up was 41 AE 51 months (range, 6 months to 19 years; median, 1 year). Of the visual acuity (VA) data in the affected eyes obtained at last follow-up (n = 333, 51%), seventy-four patients (22%) had VA of ≥6/12. Of the remaining 259 patients, 18 (7%) had mild VI, 87 (34%) had moderate VI, 58 (22%) had severe VI, and 96 (37%) were blind. No serious complications were noted. Conclusions: Primary CTT may be safely employed to control IOP and may provide long-term benefits in PCG patients.

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Section: Introductionmentioning

confidence: 99%

Combined trabeculotomy−trabeculectomy for primary congenital glaucoma: long‐term experience from a tertiary referral centre in a developing nation

Mandal

Gothwal

Khanna

2021

Acta Ophthalmologica

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“…The mean age at presentation of PCG patients was 2.7 years old, which is significantly older than the mean age at presentation of 11 months in developed countries [ 15 ], however similar to reports in developing countries [ 16 , 17 ]. Late presentation of PCG patients in the developing world is a well-known challenge [ 18 ]. Many factors contribute to this, including limited access to healthcare due to socioeconomic status, healthcare costs, physical distances required to travel to healthcare centers, and potential financial impact on parents' livelihoods.…”

Section: Discussionmentioning

confidence: 99%

Childhood glaucoma profile in a Southwestern Ethiopia tertiary care center: a retrospective study

Mulugeta,

Gebremichael,

Adugna

2024

BMC Ophthalmol

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Background Childhood glaucoma is a major cause of childhood blindness worldwide. The profile of childhood glaucoma has not been well characterized in sub-Saharan Africa. Thus, this study was designed to describe demographics, clinical features, managements of childhood glaucoma, and improvements in visual acuity (VA) and intraocular pressure (IOP) from baseline to final visit. Methods This retrospective study included glaucoma patients below 18 years old who were diagnosed between September 2019 to August 2022. Childhood glaucoma diagnosis and classification was made as per the Childhood Glaucoma Research Network Classification (CGRN). Results A total of 105 children (181 eyes) were diagnosed with glaucoma. The most common type of childhood glaucoma was primary congenital glaucoma (PCG) constituting (42%, n = 76 eyes, 95% confidence interval (CI), 34.7–49.5%; P = 0.037), followed by glaucoma suspect (22.1%, n = 40 eyes, 95% CI, 16.3–28.9%; P < 0.001) and juvenile open-angle glaucoma (JOAG) (15.5%, n = 28 eyes, 95% CI, 10.5–21.6%; P < 0.001). While the most common type of secondary glaucoma was steroid-induced glaucoma, followed by glaucoma following cataract surgery. Bilateral glaucoma was found in 72.4% (n = 76 children, 95% CI, 62.8–80.7%; P < 0.001) of children. In both primary and secondary glaucoma, boys were affected more than girls, in ratio of 2:1 and 2.7:1, respectively. The mean age at presentation for patients with PCG was 2.7 years. Close to 93.4% (71) of PCG eyes were managed surgically, of which majority underwent combined trabeculotomy and trabeculectomy (CTT). Most of secondary glaucoma cases were treated medically. Overall, 85.3% (111) of eyes had successful control of IOP ≤ 21 mmHg. Conclusion PCG was the most common type of childhood glaucoma. One of a well-recognized challenge in developing countries, late presentation of patients with PCG, was also observed in our study. Which highlights, the need of increasing access to eye-care service and awareness of childhood glaucoma as a major public health issue. Steroid-induced glaucoma was the most common type of secondary glaucoma; appropriate measures should be taken to prevent this preventable glaucoma.

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“…Transscleral cyclophotocoagulation was perfomed using a G-probe in patients with poor visual potential. 25 The power setting was 1500-2000 mW with a soft pop and and 20-25 shots were applied in 180-degrees.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Glaucoma management in congenital ectropion uveae: Surgical outcomes from a large tertiary referral center in South India

Mandal

Gothwal

2022

European Journal of Ophthalmology

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Purpose To evaluate the long-term outcomes of glaucoma management in patients with congenital ectropion uveae (CEU) over a period of three decades at a single large referral tertiary eye care center. Methods Retrospective chart review of all patients with CEU treated surgically from 1990 to 2019 was performed. Primary combined trabeculotomy-trabeculectomy (CTT), trabeculectomy with and without mitomycin-C (MMC) (0.2 mg/mL for 1 min) and transscleral cyclophotocoagulation (TSCPC) were performed. Intraocular pressure (IOP) ≥6 and ≤16 mmHg without medications was considered as complete success and IOP≤ 16 mmHg with the use of upto 2 medications as qualified success. Results A total of 26 eyes of 21 patients were identified with a median age of 7 years (range, 6 days to 19 years) at the time of glaucoma surgery. Median follow-up was 51.1 months (range, 7–244.6 months). Primary CTT was performed in 17 eyes (65%), trabeculectomy in 5 eyes (19%) with application of MMC in 2 eyes, and 3 eyes (12%) underwent TSCPC. One painful blind eye (4%) underwent evisceration. Mean IOP reduced from 30.8 ± 7.6 mmHg on a mean of 1.3 ± 0.8 glaucoma medications preoperatively to a mean IOP of 15.2 ± 5.9 mmHg (P < 0.0001) on a mean of 0.2 ± 0.5 medications postoperatively at final follow-up (P = 0.0009). Complete success was achieved in 20 eyes, and qualified success in 2 eyes. Conclusions CTT is a safe and efficacious primary procedure for management of early-onset glaucoma in CEU. Trabeculectomy with or without adjuvant MMC is a viable second line of treatment in late-onset glaucoma with CEU for IOP control.

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Childhood Glaucoma Surgery in Developing Countries

Cited by 6 publications

References 59 publications

Combined trabeculotomy−trabeculectomy for primary congenital glaucoma: long‐term experience from a tertiary referral centre in a developing nation

Combined trabeculotomy−trabeculectomy for primary congenital glaucoma: long‐term experience from a tertiary referral centre in a developing nation

Childhood glaucoma profile in a Southwestern Ethiopia tertiary care center: a retrospective study

Glaucoma management in congenital ectropion uveae: Surgical outcomes from a large tertiary referral center in South India

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