Outcome of surgical treatment of primary and secondary glaucoma in young children

Abstract

ABSTRACT.Purpose: To describe a paediatric cohort surgically treated for primary or secondary glaucoma (PG/SG), with regard to incidences, visual outcome and control of intraocular pressure (IOP). Methods: All children (n = 29, 42 eyes in total) surgically treated for PG or SG at the age of 4 years or younger between January 2002 and December 2010 at Sahlgrenska University Hospital in M€ olndal were retrospectively studied through medical records. Median follow-up time after initial surgery was 5.9 years (range 2.4-11.2 years). Results: The incidence of primary congenital glaucoma was 4.3 cases per 100 000 live births in the county of V€ astra G€ otaland. For glaucoma secondary to cataract surgery, the incidence was 13% with a median postoperative duration to diagnosis of glaucoma of 3.8 months (range 1.6 months to 4.3 years). Preoperative mean IOP was 31.5 (SD 8.1) mmHg, and mean IOP at last visit was 17.1 (SD 4.4) mmHg. For the entire cohort, 30% of the glaucoma eyes required more than two IOP-lowering surgical procedures during the study period. BCVA was ≥0.3 (decimal) in 45% of glaucomatous eyes at last follow-up with no statistically significant difference between PG and SG. Analysis of functional visual outcome, that is BCVA in the better eye, showed that 83% of all patients attained a BCVA of ≥0.5. Conclusions: The incidences and outcome of surgically treated paediatric glaucoma were in accordance with previous studies. Chamber angle surgery, and if necessary, tube implantation without the use of antimetabolites, is a favourable approach leaving most sites needed for future glaucoma surgery unaffected.

Primary congenital glaucoma in Denmark, 1977–2016

“…We found an annual incidence of PCG of 4.8 per 100 000 live born which is comparable to a study from Great Britain that reported an annual incidence (per 100 000) of 5.41 for Great Britain, 5.13 for England, 3.31 for The Republic of Ireland and 11.70 for Scotland (Papadopoulos et al 2007). A Swedish regional study similarly found an incidence of 4.3 per 100 000 (Zetterberg et al 2015). Less recent studies from other Western countries have shown similar incidence findings (Francois 1980;Gencik et al 1982;McGinnity et al 1987).…”

“…A Swedish regional study similarly found an incidence of 4.3 per 100 000 (Zetterberg et al. ). Less recent studies from other Western countries have shown similar incidence findings (Francois ; Gencik et al.…”

Analysis and management of intraoperative and early postoperative complications of bag‐in‐the‐lens intraocular lens implantation in different age groups of paediatric cataract patients: report of the Giessen Paediatric Cataract Study Group

“…Van Looveren et al (2015) in long term follow-up after bag-in-the-lens IOL implantation in children reported one case of postoperative glaucoma, but the IOP values were not reported. Nystr€ om et al (2018) in their report defined glaucoma as an IOP ≥ 22 mmHg and buphthalmus, enlarged cornea, corneal oedema, glaucomatous appearance of the optic disc, a myopic shift or an increase of axial length more than predicted based on individual growth curves (Zetterberg et al 2015). In our cohort, we defined postoperative intraocular hypertension as IOP ≥ 12 mmHg measured with applanation tonometry Perkins Tonometer Mk2 (Haag-Streit, Essex, UK) in general anaesthesia or as IOP ≥ 20 mmHg with iCare Ò PRO (Model: TA03, iCare Finland Oy, Vantaa, Finland) in the awake state, and secondary glaucomaaccording to Nystr€ om et al (2018) which was described above.…”

“…() as increase of IOP ≥ 22 mmHg measured at the beginning of the induction of general anaesthesia (Tono‐Pen XL, Reichard Inc., Depew, NY, USA), and presence of one or more following complications: buphthalmus, enlarged cornea, corneal oedema, glaucomatous appearance of the optic disc, a myopic shift or an increase of axial length more than predicted based on individual growth curves (Zetterberg et al. ). Intra‐ or postoperative bag‐in‐the‐lens IOL dislocation was defined as partial or complete displacement of the ACCC or/and PCCC out of the bag‐in‐the‐lens IOL groove.…”

“…Due to this, the postoperative intraocular hypertension was defined as IOP ≥ 12 mmHg measured with applanation tonometry Perkins Tonometer Mk2 (Haag-Streit, Essex, UK) in general anaesthesia or as IOP ≥ 20 mmHg with iCare Ò PRO (Model: TA03, Icare Finland Oy, Vantaa, Finland) in awake state. Secondary postoperative glaucoma on eyes operated with bag-inthe-lens technique was defined according to Nystr€ om et al (2018) as increase of IOP ≥ 22 mmHg measured at the beginning of the induction of general anaesthesia (Tono-Pen XL, Reichard Inc., Depew, NY, USA), and presence of one or more following complications: buphthalmus, enlarged cornea, corneal oedema, glaucomatous appearance of the optic disc, a myopic shift or an increase of axial length more than predicted based on individual growth curves (Zetterberg et al 2015). Intraor postoperative bag-in-the-lens IOL dislocation was defined as partial or complete displacement of the ACCC or/and PCCC out of the bag-in-thelens IOL groove.…”