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Early Trabeculotomy Ab Externo in Treatment of Sturge-Weber Syndrome
1Department of Ophthalmology, Ninth People's Hospital Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Early trabeculotomy in infants with Sturge-Weber syndrome (SWS) glaucoma is safe and effective. This procedure significantly reduces intraocular pressure, offering good intermediate-term outcomes for this condition.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Glaucoma Surgery
Background:
- Sturge-Weber syndrome (SWS) can cause early-onset glaucoma, leading to significant visual impairment in infants.
- Timely intervention is crucial for managing intraocular pressure (IOP) and preventing optic nerve damage in SWS patients.
Purpose of the Study:
- To assess the intermediate-term efficacy and safety of trabeculotomy in infants diagnosed with SWS-induced glaucoma.
- To identify factors associated with surgical success or failure in this patient population.
Main Methods:
- A retrospective cohort study reviewed 34 eyes of 32 infants under 12 months of age who underwent trabeculotomy for SWS-induced glaucoma.
- Data collected included preoperative IOP, corneal diameter, cup-to-disc ratio, and postoperative IOP, success rates, and medication use.
Main Results:
- Trabeculotomy led to a significant IOP reduction from baseline, sustained up to 2 years post-surgery (P < .05).
- Overall and complete success rates were 86.6% and 66.0%, respectively, at the final follow-up (median 15.5 months).
- Transient shallow anterior chamber and intraoperative hyphema were the main complications, with no other significant adverse events noted.
Conclusions:
- Early diagnosis and treatment of glaucoma in SWS patients yield better outcomes compared to later interventions.
- Trabeculotomy ab externo is a safe and effective procedure for managing early-onset glaucoma in SWS, providing good intermediate-term results.
- Elevated preoperative IOP and corneal edema are risk factors for surgical failure.
Purpose:
To evaluate the intermediate-term efficacy and safety of trabeculotomy in infant Sturge-Weber syndrome (SWS).
Design:
Retrospective cohort study.
Methods:
All SWS-induced glaucoma patients less than 12 months of age who underwent trabeculotomy at our Ophthalmology Department from August 2011 to March 2017 were reviewed. Baseline demographics, intraocular pressure (IOP), cup-to-disc ratio (C/D), and cornea diameters were noted before surgery. The IOP, success probabilities, and medication usage were recorded during follow-up until the last visit.
Results:
Overall, 34 eyes (32 patients) were included, with a median surgery age of 3 months and a median follow-up time of 15.5 months. The mean preoperative IOP, asymmetry between 2 eyes, cornea diameter, and median C/D were 21.5 ± 6.6 mm Hg, 10.1 ± 4.9 mm Hg, 12.6 ± 0.7 mm, and 0.65 (interquartile range [IQR]: 0.55, 0.80), respectively. The IOP was significantly reduced from the preoperative baseline at 1 week, 3 months, 6 months, 1 year, and 2 years after the surgery (P < .05). At the last follow-up, the cumulative proportions of overall and complete success were 86.6% and 66.0%, respectively. Complications included a transient shallow anterior chamber. Thirty of the 34 eyes had intraoperative hyphema, 27 of which lasted less than 3 days. No other complications were noted during the follow-up.
Conclusions:
Compared to previous studies with a later diagnosis of glaucoma in SWS patients, better outcomes were achieved with an early diagnosis of glaucoma in SWS patients. Early trabeculotomy ab externo was safe and led to good intermediate-term surgical outcomes for early-onset glaucoma in SWS patients. Higher preoperative IOP and corneal edema were associated with a greater risk of surgery failure.
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