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Goniotomy for initial and re-surgery for childhood glaucoma in Northern India
Sushmita Kaushik1, Gaurav Gupta1, Faisal Thattaruthody1
1Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Goniotomy is an effective surgical treatment for childhood glaucoma in Indian children. This minimally invasive procedure shows good success rates and avoids complications, offering a viable option for pediatric glaucoma management.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Research
Background:
- Childhood glaucoma presents unique challenges in management.
- Goniotomy is a surgical option for pediatric glaucoma.
- Understanding its efficacy in specific populations is crucial.
Purpose of the Study:
- To evaluate the effectiveness of goniotomy in treating childhood glaucoma in Indian eyes.
- To analyze success rates based on surgical type (primary vs. re-do) and glaucoma subtype.
- To identify predictors of successful outcomes.
Main Methods:
- Prospective analysis of pediatric glaucoma patients undergoing goniotomy from July 2017 to June 2020 in Northwest India.
- Success defined as intraocular pressure (IOP) ≤18 mm Hg with or without two topical medications.
- Follow-up at six months, one year, and two years.
Main Results:
- Goniotomy was performed on 172 eyes (37.9% of pediatric glaucoma surgeries).
- One-year success rates were 79.7% for primary PCG, 68.4% for re-do PCG, and 62% for non-PCG.
- Lower baseline IOP and shorter axial length predicted successful outcomes. Visual outcomes at one year showed varying degrees of visual impairment.
Conclusions:
- Goniotomy is an effective surgical intervention for childhood glaucoma in the Indian population.
- Its minimally invasive nature reduces the need for extensive dissection and antifibrotic agents.
- The procedure demonstrates favorable outcomes and safety in this cohort.
Purpose:
The aim of this study was to describe the effectiveness of goniotomy for childhood glaucoma in Indian eyes.
Methods:
Consecutive patients with pediatric glaucoma who underwent goniotomy between July 2017 and June 2020, in a single center in Northwest India were prospectively analyzed. Goniotomy was done as a primary procedure or a re-do surgery of the untreated angle in failed filtering surgery. Success was defined as intraocular pressure (IOP) ≦18 mm Hg with or without 2 topical medications.
Results:
A total of 172 eyes of 126 children underwent goniotomy during this period (37.9% of all pediatric glaucoma surgeries). Goniotomy comprised 132 of 211 (62.5%) primary pediatric glaucoma surgeries and 40 of 243 (16.5%) re-do surgeries. 145, 112, and 54 eyes had a six months, 1-year and 2-year follow-up, respectively. At 1 year, success rates in Primary Congenital Glaucoma (PCG) were 79.7% for primary surgery and 68.4% for re-do surgery. For non-PCG eyes, the success rate was 62% at 1 year. Among PCG subgroups, infantile and newborn glaucoma had 87.5% and 57.1% success rates, respectively. On logistic regression analysis, lower baseline IOP and lesser axial length at presentation were significantly predictive of successful outcomes (P = 0.03 and P = 0.02, respectively). At 1 year, in the primary surgery group, 50% had good vision (better than logMAR 0.5), 28.9% had moderate (better than LOGMAR 1.0) and 20% had severe visual impairment. There were no significant intraoperative or post-operative complications.
Conclusion:
Goniotomy appears to be an effective surgery for childhood glaucoma in Indian eyes. Being minimally invasive, it obviates the need for conjunctival and scleral dissection and antifibrotic agents.
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