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Antimetabolite filtration surgery with releasable sutures, bleb needling can treat primary childhood glaucoma

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Antimetabolite and releasable augmentation of filtration surgery can be an effective long-term treatment option for refractory primary pediatric glaucomas, a study by researchers in the United Kingdom suggests. However, patients with secondary glaucomas do not show good long-term success after cataract surgery, according to the study, published in the April issue of Journal of AAPOS.

"There were no major or sight-threatening complications in our series; no eyes developed cystic avascular blebs or bleb-related infections," the study authors said.

Sancy Low, BSc(Hons), MRCOphth, and colleagues retrospectively reviewed surgical results after performing either trabeculectomy or combined trabeculotomy-trabeculectomy — using antimetabolites, releasable sutures and bleb needling with 5-fluorouracil — on 38 eyes of 30 pediatric glaucoma patients between 1999 and 2004. Of these patients, 25 patients (33 eyes) had primary congenital glaucoma, and five patients (five eyes) had either aphakic or pseudophakic secondary glaucoma. Specifically, all patients younger than 1 year underwent combined trabeculotomy-trabeculectomy; patients older than 1 year received trabeculectomy alone. One patient with primary congenital glaucoma subsequently received trabeculotomy-trabeculectomy at 24 months.

Overall, 89% of the patients had previously undergone failed glaucoma surgery, the authors noted.

Mean follow-up ranged from 5.2 months to 68.5 months, for an average of 22.9 months.

Of 38 total eyes, 66% had suture-release and 68% had an average of 1.9 bleb-needling procedures. Five eyes (13%) required further drainage tube surgery, the authors reported.

Three patients who averaged 7.4 months of age at baseline had early postoperative hypotonies that required anterior chamber re-inflation. Additionally, two patients had transient wound leaks. The investigators reported no cases of endophthalmitis or bleb-related complications.

No eyes developed avascular, thin or cystic blebs, according to the study.

"Cumulative success was 75% for primary but only 21% for secondary glaucoma at final follow-up," the researchers said.