[Trabeculectomy as the initial procedure in primary congenital glaucoma]
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B Koraszewska-Matuszewska1, E Samochowiec-Donocik, E Pieczara
1Z Kaedry i Kliniki Okulistyki Dzieciecej Slaskiej AM w Katowicach.
Insights
Trabeculectomy is an effective surgical treatment for primary congenital glaucoma in infants and older children with buphthalmos. This procedure helps stabilize intraocular pressure for many years, even when performed on neonates.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Primary congenital glaucoma, or buphthalmos, presents challenges in pediatric eye care.
- Early intervention is crucial for managing elevated intraocular pressure and preventing vision loss.
Purpose of the Study:
- To evaluate the long-term effectiveness of trabeculectomy as a primary surgical treatment for buphthalmic eyes in children.
- To assess the efficacy of trabeculectomy in different age groups of pediatric glaucoma patients.
Main Methods:
- A retrospective study involving 42 eyes of 24 children (7 days to 7 years) with primary congenital glaucoma.
- Forty-five trabeculectomies were performed, with follow-up ranging from 1 to 22 years (mean 82 months).
- Patients were divided into two groups: infants (7 days to 12 months) and older children (3 to 7 years).
Main Results:
- Trabeculectomy achieved normal intraocular pressure (IOP) in 95.2% of eyes.
- Successful IOP normalization was observed in 68.9% of infants and 50% of older children.
- Additional medical treatment was required in some cases, but overall IOP was maintained below 21 mm Hg in 97% of infants and 90% of older children.
Conclusions:
- Trabeculectomy is a safe and effective first-line surgical procedure for primary congenital glaucoma in buphthalmic eyes across a wide pediatric age range.
- The procedure offers long-term IOP stabilization, even in very young infants and neonates, challenging assumptions of poor prognosis.
- Pediatric glaucoma management with trabeculectomy can lead to sustained visual health over many years.
Purpose:
To estimate the effectiveness of trabeculectomy performed in buphthalmic eyes.
Material And Methods:
42 eyes of 24 children, 14 boys and 10 girls. There were 18 children (32 eyes) operated on at the age from 7 days to 12 months (group I) and 6 patients (10 eyes) at the age from 3 to 7 years (group II) with primary congenital glaucoma. Corneal diameter ranged from 11.5 to 15 mm in infants, in 10 eyes of 6 children elder than 2 years it was from 13 to 15 mm. The axial length of eyeballs was from 19 to 23.5 mm. Forty five trabeculectomies were performed, in 3 cases they were repeated two and six years after the first procedure. Follow up was from 1 year to 22 years, mean 82 months, 7 years of group I, 6 years of group II.
Results:
29 of 42 eyes (64.2%) with intraocular pressure varied between 8 and 21 mm Hg, other eyes required additional local antiglaucoma treatment. Normal IOP was obtained in 95.2% of eyes. Trabeculectomy normalized IOP in 68.9% eyes of infants (group I), whereas in elder children the percentage came up to 50 (group II). In other eyes pharmacological agents decreased IOL to values below 21 mm Hg, in the group I in 97% of eyes and in the group II in 90% of cases.
Conclusion:
Trabeculectomy performed as a first procedure in primary congenital glaucoma is effective in infants and older children with buphthalmos in long-term follow-up. The necessity to perform this operation in very small children and even neonates does not always mean poor prognosis, and intraocular pressure can be stabilized at safe level for many years.
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