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Antimetabolite and releasable suture augmented filtration surgery in refractory pediatric glaucomas

Sancy Low1, Samer Hamada, Ken K Nischal

  • 1Department of Clinical and Academic Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|December 18, 2007
PubMed

Insights

This study evaluated filtration surgery for childhood glaucoma, finding it effective for primary cases but less so for secondary glaucomas. The procedure, using releasable sutures and antimetabolites, showed favorable outcomes with minimal complications.

Area of Science:

  • Ophthalmology
  • Pediatric Surgery
  • Glaucoma Research

Background:

  • Childhood glaucoma requires effective surgical interventions.
  • Refractory pediatric glaucomas often necessitate advanced surgical techniques.
  • Evaluating surgical adjuncts like releasable sutures and antimetabolites is crucial.

Purpose of the Study:

  • To assess the efficacy of filtration surgery using releasable sutures, antimetabolites, and bleb-needling with 5-fluorouracil (5FU) in pediatric glaucoma.
  • To compare outcomes in primary versus secondary childhood glaucomas.

Main Methods:

  • Retrospective review of 30 patients (38 eyes) with childhood glaucoma treated between 1999-2004.
  • Surgical procedures included trabeculectomy or combined trabeculotomy-trabeculectomy with antimetabolites and releasable sutures.
  • Success defined as intraocular pressure ≤21 mmHg with ≤2 topical medications.

Main Results:

  • Cumulative success rates were 75% for primary glaucoma and 21% for secondary glaucoma.
  • Sixty-six percent of eyes had suture release, and 68% underwent bleb needling.
  • Complications included early hypotony and transient wound leaks; no sight-threatening issues or bleb infections occurred.

Conclusions:

  • Filtration surgery augmented with antimetabolites and releasable sutures shows promise for refractory primary pediatric glaucomas.
  • Long-term success is limited in secondary glaucomas, particularly those post-cataract surgery.
  • The surgical approach demonstrated a favorable safety profile without major complications.
Abstract

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