Primary congenital glaucoma surgery: outcomes and visual function

Abstract

Purpose To assess the long-term visual outcomes of children with PCG, irrespective of the type of surgical procedure, and to create visual acuity curves to help in predicting the development of visual function in these patients. The secondary aim is to identify associated factors for visual decline or loss, highlighting differences between neonatal and infantile subgroups. Methods The medical records of pediatric glaucoma patients from 1996 to 2017 at the University Hospital of Verona (Verona, Italy) were retrospectively reviewed. Visual acuities, surgeries, PCG subtype and etiology of vision impairment were recorded. Statistical analyses were performed to detect factors associated with vision decline. Results Sixty-seven eyes (40 patients) were included in the study. Developmental predictive curves of visual acuity showed that children with infantile PCG had a better visual outcome than children with neonatal PCG at each step of follow-up. A good-to-moderate VA (< 1 LogMAR) was achieved in 56 eyes (83.6%), while 11 eyes (16.4%) had poor VA (≥ 1 LogMAR). The age at onset, sex, number of surgeries, intraocular pressure (IOP) control (with or without antiglaucoma drugs), axial length (AL) and corneal opacities were statistically associated with vision impairment (p < 0.01). The main cause of visual impairment was amblyopia. Conclusions Visual outcomes of PCG significantly correlate with the age at diagnosis. Although a good long-term IOP control can often be achieved in PCG, often the visual acuity remains below the lower limits of the normal range. Poor vision in childhood is related to global developmental problems, and referral to third-level services should not be delayed to prevent vision impairment. In this regard, visual acuity curves can be a useful tool for the consultant ophthalmologist to define the visual development of children affected by PCG.

Visco-Circumferential-Suture-Trabeculotomy Versus Rigid-Probe Viscotrabeculotomy in Neonatal-Onset Primary Congenital Glaucoma

“…El Sayed and Gawdat 11 showed that CT, using the illuminated microcatheter or rigid-probe trabeculotomes, yields a success rate of 77% in eyes with PCG (not of neonatal-onset type) after a follow-up period of 21.2 months. These success rates are clearly lower than those reported for other types of PCG 28,29 reflecting again how the disease is severe and difficult to control. The relative stability of the AL in the first 4 years of life in this study is in contradistinction to other published reports 30 of progressively increasing AL over the first 3–4 years of life.…”

Analysis of research hotspots and trends in pediatric ophthalmopathy based on 10 years of WoSCC literature

“…Surgical treatments for childhood glaucoma are a significant research area, encompassing procedures such as trabeculotomy ( 52 ), combined trabeculotomy-trabeculectomy ( 53 ), angio-atriotomy ( 54 ), Ahmed glaucoma drainage device implantation ( 55 , 56 ), Baerveldt glaucoma drainage device implantation ( 57 ), ciliary body photocoagulation ( 58 ), and XEN gel stent implantation ( 59 ), as well as penetrating otoplasty for refractory cases ( 60 ). Visual outcomes have been correlated with factors such as age at diagnosis, corneal clouding, and the presence of concurrent amblyopia ( 61 , 62 ). Recent research has also identified associations with genetic mutations ( 63 , 64 ).…”

Risk Factors for Trabeculotomy Failure in Primary Congenital Glaucoma

“…Moreover, El Sayed et al 8 showed that a younger age at presentation were strongly associated with trabeculotomy failure and insufficient IOP reduction. Gusson et al 13 showed that poorer visual outcomes after trabeculotomy were significantly correlated with the younger age at diagnosis. Hassanein et al 14 reported that surgery within first month of life was stand-alone risk factor for early and late surgical failure in patients with PCG.…”