Updates on the Surgical Management of Pediatric Glaucoma

Tan, Yar-Li; Chua, Jocelyn; Ho, Ching-Lin

doi:10.1097/apo.0000000000000182

Cited by 18 publications

(28 citation statements)

References 77 publications

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“…Even in experienced hands, there is a risk of failure of the first trabeculotomy/goniotomy and medical therapy may be reinstituted or additional surgery may be performed. Additional surgeries if the primary trabeculotomy fails may be a new trabeculotomy if the angle was not opened 360 degrees at the initial surgery, filtration surgery, implantation of drainage devices or cyclodestructive procedures (Tan et al 2016).…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…Goniotomy and trabeculotomy are preferred as the initial surgical intervention for patients with PCG because of their effectiveness in reducing the IOP and their relatively low rate of serious complications. [ 4 5 11 ] The advantages of goniotomy are not to disturb the conjunctiva if filtering surgery is subsequently needed, but it requires a clear cornea to afford an adequate intraoperative view of the angle. [ 12 13 ] In the current study, all of the patients had corneal edema, which made goniotomy difficult to perform.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Trabeculotomy in Newborns with Primary Congenital Glaucoma

Huang

Zhong

et al. 2016

Chinese Medical Journal

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Background:Early surgical intervention is required for the primary congenital glaucoma (PCG). There are currently few reports on the surgical outcomes in infants with PCG. This study aimed to evaluate the efficacy and safety of trabeculotomy and the postoperative visual outcomes in Chinese newborns with PCG within 4 weeks of birth.Methods:A total of 21 eyes of 12 patients with PCG who underwent primary trabeculotomy within 4 weeks of birth were retrospectively studied. Preoperative and postoperative intraocular pressure (IOP), corneal clarity and diameter, axial length and optic disc cupping, visual acuity and postoperative refractive error, success rates, and complications were evaluated. Kaplan-Meier survival analysis was applied to evaluate the success rates.Results:The mean follow-up time was 46.9 ± 34.4 months (range: 12–122 months). The postoperative IOP was significantly lower than the preoperative IOP at all of the follow-up visits (P < 0.001). The complete success rates for all eyes at 1, 2, 3, and 5 years postoperatively were 90.5%, 85.7%, 85.7%, and 85.7%, respectively. The IOPs of the three patients who needed antiglaucomatous medications postoperatively were also well controlled. At the last visit, the cornea became clear, and the cup-to-disc ratio decreased significantly (P = 0.01) although the horizontal corneal diameter did not change significantly (P = 0.11). Visual acuities were able to be recorded in eight eyes at the last visit, among which six eyes had a best-corrected visual acuity of 20/40 or better. There were no severe intraoperative or postoperative complications.Conclusions:Trabeculotomy proves to be a safe and effective treatment in reducing IOP in this group of Chinese newborns with PCG. The outcomes of vision function were satisfactory in most of the patients.

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“…When the cornea is hazy and precludes good visualization, an ab externo trabeculotomy is preferred. 41 The traditional technique for a trabeculotomy uses an external access to the canal of Schlemm via a partial scleral flap. A trabeculotome opens 90 degrees of the canal which can then be rotated into the anterior chamber to incise through the trabecular meshwork.…”

Section: Surgical Therapymentioning

confidence: 99%

Pediatric Glaucoma: Diagnosis, Management, Treatment

Barke¹,

Dhoot²,

Feldman³

2021

International Ophthalmology Clinics

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According to the World Glaucoma Association (WGA), pediatric glaucoma comprises all disorders with elevated intraocular pressure (IOP)-related damage to the eye in childhood. Unlike adult glaucoma, this definition is not solely based on optic nerve appearance or visual field defects which can be difficult to ascertain in children. Many classification schemes have been used to organize pediatric glaucomas but consensus in the 2013 WGA meeting organizes pediatric glaucomas as primary or secondary. The primary forms, as previously mentioned, include PCG and JOAG. Secondary forms can be acquired from trauma, uveitis, steroid use, tumor, retinopathy of prematurity, or after cataract surgery. Secondary nonacquired forms can include those associated with systemic conditions such as chromosomal disorders, phakomatoses, or those associated with ocular abnormalities such as Axenfeld-Rieger, aniridia, peters anomaly, and iridotrabecular dysgenesis 14 (Table 1).While the WGA discourages the use of words with inconsistent definitions such as developmental, congenital, or infantile, PCG is frequently broken down by age of presentation to: (1) newborn onset (0 to 1 mo), (2) infantile onset (1 to 24 mo), (3) late onset or late recognized ( > 24 mo), and (4) spontaneously arrested cases. Spontaneously arrested cases are rare but represent cases with normal IOP and optic discs but with other typical signs of PCG that are not progressive. Timing of diagnosis may be different in areas with variable health care access and is influenced by severity of disease. While PCG will commonly present between 3 and 9 months of age, newborn onset is the most severe. 15 Etiology and PathogenesisPCG is most often sporadic, however, there are autosomal recessive cases with penetrance ranging from 40% to 100%. 16 Linkage analysis have thus far identified 5 loci that are involved with the development of PCG: GLC3A (located on chromosome 2p22-p21), GLC3B (1p36.2-p36.1), GLC3C (14q24.3), GLC3D (14q24.2-q24.3, not overlapping with GLC3C), and GLC3E (9p21) (16,18). Genes have been identified with 3 of the 5 loci. The GLC3a loci contains the CYP1B1 gene, the GLC3D locus contains latent transforming growth factor beta binding protein 2 (LTBP2) and the GLC3E loci contains tunica internal endothelial cell kinase gene (TEK/TIE2). 15 CYP1B1 mutations are associated with 15% to 20% of PCG cases in Japan and the United States and LTBP2 mutations have been reported in consanguineous Iranian, Pakistani, and Slovakian Roma families. 4,[17][18][19] Genetic testing can identify a cause in 40% of cases of PCG; in cases of parental consanguinity, it is essential to screen current and future siblings. 4

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Updates on the Surgical Management of Pediatric Glaucoma

Cited by 18 publications

References 77 publications

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

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

Surgical Outcomes of Trabeculotomy in Newborns with Primary Congenital Glaucoma

Pediatric Glaucoma: Diagnosis, Management, Treatment

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