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Abstract #10409 Published in IGR 6-1
Surgical management of glaucoma in infants and children with Peters' anomaly: long-term structural and functional outcome
Yang LL; Lambert SR; Lynn MJ; Stulting RDOphthalmology 2004; 111: 112-117
OBJECTIVE: To determine the long-term outcome of surgery for congenital glaucoma in infants and children with Peters' anomaly. DESIGN: Retrospective review of a consecutive interventional case series. SETTING: An urban academic tertiary referral institution. PARTICIPANTS: Thirty-four eyes of 19 children are subjects of this report. Included are all children 12 years of age or younger with Peters' anomaly who underwent surgery for primary congenital glaucoma between January 1971 and December 1992 and completed a minimum of three years of follow-up from the date of the first glaucoma surgery. INTERVENTION: The surgical procedures performed were trabeculectomy, trabeculotomy, goniotomy, Molteno shunt implantation, cyclodialysis, and cyclocryotherapy. MAIN OUTCOME MEASURES: Primary outcome measures were intraocular pressure (IOP) control and final postoperative visual acuity. IOP control was defined as complete success (IOP ≤ 21 mmHg without antiglaucoma medication), qualified success (IOP ≤ 21 mmHg with antiglaucoma mediation), or failure (IOP > 21 mmHg with or without antiglaucoma medication, inoperable retinal detachment, phthisis, or chronic hypotony, defined as an IOP of ≤ 6 mmHg). RESULTS: A total of 126 glaucoma procedures were performed on 34 eyes of 19 patients. The median age at time of first glaucoma surgery was 2.1 months (range, two days to 8.5 years). The median follow-up was 11.0 years (range, 3.2-22.8 years) from the time of first glaucoma surgery. IOP control with or without antiglaucoma medication was achieved in 11 eyes (32%) after one or more surgical procedures. Major postoperative complications included graft failure in 26 eyes (76%), cataract in six eyes (18%), inoperable retinal detachment with phthisis in 12 eyes (35%), and phthisis alone in six eyes (18%). Final vision was 20/200 or better in three eyes (9%), 20/400 to hand motion in 12 eyes (35%), light perception in seven eyes (21%), and no light perception in 12 eyes (35%). CONCLUSIONS: Glaucoma surgery, combined with medical therapy, may result in adequate, long-term IOP control in 32% of eyes with glaucoma associated with Peters' anomaly. Visual results are poor due to uncontrolled glaucoma, amblyopia, neurological impairment, and other anterior and posterior segment anomalies that may accompany Peters' anomaly. Postoperative complications, including graft failure, cataract, inoperable retinal detachment, and phthisis, also contribute to decreased visual acuity.
Classification:
9.1.3 Syndromes of Axenfeld, Rieger, Peters, aniridia (Part of: 9 Clinical forms of glaucomas > 9.1 Developmental glaucomas)
12.1 General management, indication (Part of: 12 Surgical treatment)
