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Abstract #16986 Published in IGR 9-1
Long-term results of surgery in childhood glaucoma
Alsheikheh A; Klink J; Klink T; Steffen H; Grehn FGraefe's Archive for Clinical and Experimental Ophthalmology 2007; 45: 195-203
See also comment(s) by Teresa Chen •
PURPOSE: The aim of this study is to assess the functional results and morphological parameters in children surgically treated for glaucoma. METHODS: Data from 43 patients and 68 eyes who were operated in our department between 1990 and 2002 were collected. This retrospective trial included primary congenital glaucoma (n = 36), and secondary glaucoma (n = 7) in Rieger-Axenfeld syndrome and Sturge Weber syndrome. Intraocular pressure (IOP), axial length of the eyeball, visual acuity, refractive errors and orthoptic status were analysed. RESULTS: The age of patients at the first surgery was 6.0 ± 5.3 months (range 0.7 to 28.0 months). The mean period of follow-up was 57.3 ± 36.8 months (6.0-161.0).The mean number of surgical procedures performed on one eye was 2.5 ± 2.4 procedures (1-11). The mean IOP before the first surgery was 31.0 ± 7.9 mmHg (17.5-52.0), and was 15.0 ± 3.9 mmHg (7.0-28.0) at the last visit. 49 eyes (72.1%) did not need any further medical treatment after the last surgical procedure. The IOP was 18 mmHg or lower without medication in 29 eyes (42.6%) after just one surgical procedure (21 trabeculotomy, 8 combined trabeculotomy/trabeculectomy with or without mitomycin-C). At the first examination, the mean axial length of the eyeball was 22.6 ± 1.8 mm (the mean normal value at this age is 20.3 ± 0.7 mm), and was 24.4 ± 2.0 mm at the last visit (the mean normal value at this age is 22.2 ± 0.6 mm). The best corrected visual acuity at the last visit was 0.25 ± 4.6 lines; the normal range of visual acuity at this age is from 0.4 ± 4.0 lines to 0.8 ± 3.0 lines. Visual acuity was 0.32 or more in 53.0% of the eyes. Visual acuity was lower than 0.1 in only 15.2% of the eyes. Myopia was present in 57.4% of the eyes with a mean spherical equivalent of -6.1±3.9 dioptres. 15 patients (34.9%) developed strabismus. 22 patients (51.2%) were treated with part-time occlusion. Binocular function as assessed with the Lang-1 test was positive in 17 of 30 patients (56.7%). CONCLUSIONS: Although a good long-term IOP-control can often be achieved in childhood glaucoma, the visual acuity remains below the normal range in most cases despite close orthoptic follow-up.
Dr. A. Alsheikheh, University Eye Hospital Wuerzburg, Josef-Schneider-Str.11, 97080, Würzburg, Germany, f.grehn@augenklinik.uni-wuerzburg.de
Classification:
9.1.1 Congenital glaucoma, Buphthalmos (Part of: 9 Clinical forms of glaucomas > 9.1 Developmental glaucomas)
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)
