Hari Jayaram1, Richard Scawn2, Francisco Pooley3, Mark Chiang4, Catey Bunce5, Nicholas G Strouthidis6, Peng Tee Khaw7, Maria Papadopoulos8. 1. Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Casey Eye Institute, Oregon Health & Science University, Portland, Oregon. 2. Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom. 3. Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; Glaucoma Department, Fundación Oftalmológica Los Andes, Santiago, Chile. 4. Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Glaucoma Department, Queensland Eye Institute and City Eye Centre, Brisbane, Australia. 5. National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; London School of Hygiene & Tropical Medicine, London, United Kingdom. 6. Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Singapore Eye Research Institute, Singapore, Republic of Singapore; Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia. 7. Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom. 8. Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom. Electronic address: maria.papadopoulos@moorfields.nhs.uk.
Abstract
PURPOSE: To evaluate the long-term effectiveness and safety of mitomycin C (MMC)-augmented trabeculectomy undertaken within the first 2 years of life for the surgical management of glaucoma. DESIGN: Retrospective, consecutive, noncomparative case series. PARTICIPANTS: All children who underwent MMC-augmented trabeculectomy within 2 years of birth between May 2002 and November 2012. METHODS: The medical records of 40 consecutive eyes of 26 children who underwent surgery by a single surgeon were reviewed. Data collected during routine clinical care were analyzed. MAIN OUTCOME MEASURES: Assessment of clinical outcomes included intraocular pressure (IOP), final visual acuity, bleb morphology, surgical complications (early and late), postoperative interventions, and further glaucoma surgery performed. Surgical success was defined as final IOP of 5 mmHg or more and of 21 mmHg or less, with anti-glaucoma medications (qualified success) and without (complete success), stable ocular dimensions and optic disc cupping, and no further glaucoma surgery (including needling) or loss of light perception. Surgical outcomes were evaluated using Kaplan-Meier life table analysis. RESULTS: Forty eyes of 26 children were studied over a mean follow-up period of 62.8 months. Most cases (80%) were of primary congenital glaucoma after failed goniotomy surgery. Cumulative probabilities of survival at 1, 5, and 7 years were 78%, 67%, and 60%, respectively. Of eyes regarded as successful, 96% (25/26 eyes) had controlled IOP without topical medication and 44% achieved visual acuity of 20/40 or better. In only 1 of the 40 eyes did a cystic avascular bleb develop, with all the other eyes being non-cystic in nature (diffuse and elevated or flat) at final follow-up. Sixty-four percent (9/14 eyes) of cases regarded as failures ultimately underwent glaucoma drainage device implantation. CONCLUSIONS: A contemporary pediatric trabeculectomy technique augmented with MMC is an effective procedure in the management of glaucoma within the first 2 years of life, as shown by the successful long-term outcomes and low incidence of sight-threatening complications. Trabeculectomy after failed goniotomy surgery or as a primary surgical intervention may offer a phakic infant with glaucoma an excellent opportunity to achieve long-term control of IOP without medications and may be associated with optimal visual outcomes.
PURPOSE: To evaluate the long-term effectiveness and safety of mitomycin C (MMC)-augmented trabeculectomy undertaken within the first 2 years of life for the surgical management of glaucoma. DESIGN: Retrospective, consecutive, noncomparative case series. PARTICIPANTS: All children who underwent MMC-augmented trabeculectomy within 2 years of birth between May 2002 and November 2012. METHODS: The medical records of 40 consecutive eyes of 26 children who underwent surgery by a single surgeon were reviewed. Data collected during routine clinical care were analyzed. MAIN OUTCOME MEASURES: Assessment of clinical outcomes included intraocular pressure (IOP), final visual acuity, bleb morphology, surgical complications (early and late), postoperative interventions, and further glaucoma surgery performed. Surgical success was defined as final IOP of 5 mmHg or more and of 21 mmHg or less, with anti-glaucoma medications (qualified success) and without (complete success), stable ocular dimensions and optic disc cupping, and no further glaucoma surgery (including needling) or loss of light perception. Surgical outcomes were evaluated using Kaplan-Meier life table analysis. RESULTS: Forty eyes of 26 children were studied over a mean follow-up period of 62.8 months. Most cases (80%) were of primary congenital glaucoma after failed goniotomy surgery. Cumulative probabilities of survival at 1, 5, and 7 years were 78%, 67%, and 60%, respectively. Of eyes regarded as successful, 96% (25/26 eyes) had controlled IOP without topical medication and 44% achieved visual acuity of 20/40 or better. In only 1 of the 40 eyes did a cystic avascular bleb develop, with all the other eyes being non-cystic in nature (diffuse and elevated or flat) at final follow-up. Sixty-four percent (9/14 eyes) of cases regarded as failures ultimately underwent glaucoma drainage device implantation. CONCLUSIONS: A contemporary pediatric trabeculectomy technique augmented with MMC is an effective procedure in the management of glaucoma within the first 2 years of life, as shown by the successful long-term outcomes and low incidence of sight-threatening complications. Trabeculectomy after failed goniotomy surgery or as a primary surgical intervention may offer a phakic infant with glaucoma an excellent opportunity to achieve long-term control of IOP without medications and may be associated with optimal visual outcomes.
Authors: Abdulrahman H Badawi; Ahmed A Al-Muhaylib; Adi Mohammed Al Owaifeer; Rakan S Al-Essa; Sami A Al-Shahwan Journal: Saudi J Ophthalmol Date: 2019-11-07
Authors: Elena Gusson; Francesca Chemello; Rosa Longo; Elia Franzolin; Roberta Vesentini; Giuseppe Verlato; Giorgio Marchini Journal: Int Ophthalmol Date: 2021-07-23 Impact factor: 2.031