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Abstract #27920 Published in IGR 13-1
Surgical results in the management of advanced primary congenital glaucoma in a rural pediatric population
Ben-Zion I; Tomkins O; Moore DB; Helveston EMOphthalmology 2011; 118: 231-235
Objective: To present the anatomic and functional results of surgical treatment for advanced primary congenital glaucoma (PCG) in a rural setting. Design: Retrospective, observational case series. Participants: Forty eyes of 22 consecutive patients diagnosed with PCG and who underwent surgical treatment. Methods: All eyes underwent surgical treatment for PCG. Type of surgery and postoperative complications were noted. We examined anatomic and functional indices before and after the operation. Main Outcome Measures: Visual acuity (VA), intraocular pressure (IOP), refractive spherical error, cup-to-disc ratio (CDR), and horizontal corneal diameter (HCD). Results: Average age at the time of surgery was 3.3 years (range, 0.410) and the mean follow-up was 6 months (range, 111). 15% showed marked lens dislocation owing to the severe buphthalmos at presentation. Preoperative IOP was 54(plus or minus)2 mmHg, HCD was 15.1(plus or minus)0.3 mm, and CDR (when visible) was 0.8(plus or minus)0.02. Surgical intervention included 31 trabeculotomies, 6 Ahmed Glaucoma Valve implants, 1 goniotomy, and 2 eviscerations. Serious complications were noted in 4 eyes. Final postoperative IOP was 23(plus or minus)2 mmHg (P<0.0001). Patients were significantly more likely to have ambulatory VA (following objects or better) after operation (18% vs 64%; P<0.0001). Conclusions: Our surgical outcomes in children with advanced PCG demonstrated moderate overall improvement in IOP and modest improvement of VA. Deep deprivation amblyopia, severe disease manifestation at presentation, opaque corneas, and frequent lens dislocation limited the possible success. These data further signify the need for effective, timely screening of children and prompt recognition by health care workers to reduce the rate of avoidable blindness in developing countries. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
I. Ben-Zion. Department of Ophthalmology, Bnei-Zion Medical Center, Haifa, Israel. itaybenzion@gmail.com
Classification:
9.1.1 Congenital glaucoma, Buphthalmos (Part of: 9 Clinical forms of glaucomas > 9.1 Developmental glaucomas)
13.1 Prognostic factors (Part of: 13 Therapeutic prognosis and outcome)