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Angle surgery effective long-term in children with glaucoma
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Researchers found a favorable visual acuity outcome over a 21-year period in children with primary congenital glaucoma who underwent angle surgery.
The retrospective study included patients who underwent trabeculotomy, trabeculectomy or combined trabeculotomy-trabeculectomy (CTT) for primary congenital glaucoma.
Researchers compared visual acuity, surgeries and underlying cause of visual impairment in 53 eyes. Median age at diagnosis was 2 months, and sex distribution between male and female patients was equal.
Primary surgical intervention was CTT for 26 eyes, trabeculotomy for 19 eyes and trabeculectomy for eight eyes. Nine eyes required a second surgery.
The mean logMAR visual acuity was 0.61.
A good visual acuity was attained in 27 eyes (51%), moderate in 16 eyes (30%) and poor in 10 eyes (19%). The mean spherical equivalent of refraction was -4.47. The predominant refraction errors were myopia (74%) and astigmatism greater than 2 D (40%).
The mean IOP at presentation was 26.23 mm Hg and 14.96 mm Hg at final follow-up, representing a 42.9% reduction, according to the study. There was no statistically significant correlation between visual acuity categories, with or without medication.
Also, the researchers reported no correlation between mean spherical equivalent of refraction and medication use.
None of the studied risk factors – age at surgery, sex, laterality, type of initial glaucoma surgery, number of surgeries or type of control – were statistically associated with moderate to poor visual outcome, according to researchers.
The researchers also highlighted the role of topical antiglaucoma medication in improving the success rate of surgery remarkably without risking visual outcome. – by Abigail Sutton
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Congenital glaucoma is a blinding condition that requires early surgical intervention – trabeculotomy, trabeculectomy or both surgeries combined. In this retrospective study, Yassin finds that surgical intervention is indeed associated with reasonably good visual outcomes.
As optometrists, a secondary study goal is perhaps more interesting. They also found that use of topical antiglaucoma medication improves the success rate after surgery without risking visual outcome.
Congenital glaucoma appears on the surface to have little in common with the largely age-related glaucomas common in our practices. However, successful glaucoma management, congenital or otherwise, requires early diagnosis, extensive patient/parent education, informed and appropriate treatment, and a lifetime of monitoring and treatment adjustment. Failure in any one of these areas increases the likelihood of blindness. While optometrists are not able to provide surgical care, we can play a vital role before and after surgery.
As glaucoma managers, we are in it for the long haul. If your patient happens to have congenital glaucoma, the need for continued care and careful management is even more important.
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