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Editors Selection IGR 9-1

Surgery: Surgical IOP control in children

Comment by Teresa Chen on:

16986 Long-term results of surgery in childhood glaucoma, Alsheikheh A; Klink J; Klink T et al., Graefe's Archive for Clinical and Experimental Ophthalmology, 2007; 45: 195-203

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Alsheikheh et al. (186) describe the functional results and morphological parameters in children after various types of surgical treatment for glaucoma. Data were collected from 68 eyes of 43 patients who were operated at University Eye Hospital Würzburg from 1990 to 2002 (mean follow-up: 57.3 ± 36.8 months). Diagnoses included primary congenital glaucoma and secondary glaucomas (i.e., Axenfeld-Rieger and Sturge Weber). Surgical interventions included goniotomy, trabeculotomy, trabeculectomy, combined trabeculotomy/trabeculectomy with or without mitomycin C, and cyclocryotherapy. Because the eyes had different types and numbers of surgeries performed, the authors point out that the paper's focus was on outcomes of childhood glaucoma in general and not on outcomes of specific surgeries or diagnoses.

Despite good long-term intraocular pressure control in many of these children, visual acuity remains below the normal range in most cases

Notably, since all follow-up exams and eye pressure readings in younger patients were obtained under general anesthesia (ketamine or inhalation), the authors emphasize that axial length may be a more sensitive biometric than corneal diameter for follow-up of these patients after surgery. There was an approximately 2-mm difference in axial length between surgically treated congenital glaucoma and normal eyes, and this difference was maintained throughout the study follow-up. Although myopia was present in 57.4% of eyes (mean spherical equivalent of -6.1 ± 3.9 diopters), it would have been interesting if the authors had presented theories at to why there were not more eyes with axial myopia. Of the 61 eyes that had cup-disc (CD) ratio completely recorded, 29.5% had the CD increase from 0.47 to 0.73, and 31.2% had the CD decrease from 0.61 to 0.39. In general, stratification of the different clinical diagnoses and surgeries would have lead to more interesting data.

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