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

Abstract

Purpose: To report the outcomes of a 120-degree goniotomy (GT) with or without secondary intraocular lens (IOL) implantation in glaucoma following cataract surgery (GFCS). Design: Prospective, observational study. Methods: Pediatric patients with GFCS who underwent standalone 120-degree GT or 120-degree GT combined with secondary IOL implantation (GT+IOL) from March 2022 to August 2022 at the Zhongshan Ophthalmic Center were recruited. Primary outcomes were intraocular pressure (IOP) and the number of ocular hypotensive medications. A secondary outcome was the surgical success rate. Success was defined as a postoperative IOP within the range of 5–21 mm Hg. Complete and qualified successes were defined, as the above, without and with ocular hypotensive medications, respectively. Results: Thirty-two eyes of 22 patients were included. The mean age at the time of GT was 68.5 ± 29.3 months. The mean follow-up duration was 12.2 ± 2.3 months (9–15 mo). Mean IOP decreased from 30.9 ± 4.8 mm Hg on 2 (interquartile range = 1) medications at baseline to 15.8 ± 3.6 mm Hg on 0 (interquartile range = 1.5) medication at the latest visit in all eyes. The overall complete and qualified success rates were 68.8% and 90.6%, respectively. There were no significant differences in IOP, number of medications, and complete and qualified success rates between the standalone GT and GT+IOL groups at the latest follow-up at 9 months postoperatively. Conclusions: To reduce the need for additional surgery, 120-degree GT was a safe and effective surgical treatment for GFCS in children, which could be combined with secondary IOL implantation in aphakic eyes with GFCS.

CRISPR-Cas9-mediated deletion of carbonic anhydrase 2 in the ciliary body to treat glaucoma

“…IOP reduction is a surrogate outcome to quantify intervention effectiveness, 45 , 46 and randomized trials have consistently shown that a 20% reduction in IOP from baseline halved the 5-year rate of glaucoma onset in the Ocular Hypertension Treatment Study, 47 and a 25% reduction significantly delayed glaucoma progression in the Early Manifest Glaucoma Trial. 48 However, in the present study, the suppression of Car2 mediated by the dual-target CRISPR system led to an average 18% reduction in normal mice and 40% reduction in glaucoma model mice, which is comparable to the decrease in IOP previously reported with disruption of aquaporin 1 24 or mutant myocilin .…”