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Influence of different primary surgical techniques on long-term intraocular pressure and medication in glaucoma after
Alicja Strzalkowska1, Piotr Strzalkowski2, Julia V Stingl1
1Childhood Glaucoma Center, Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.
Insights
Primary surgical treatments, including probe trabeculotomy and 360° catheter-assisted trabeculotomy, effectively reduce intraocular pressure (IOP) in children with glaucoma after congenital cataract surgery. These procedures offer long-term IOP control, potentially reducing the need for glaucoma medications.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Research
Background:
- Congenital cataract surgery can lead to secondary glaucoma in children.
- Effective long-term management of pediatric glaucoma post-cataract surgery is crucial.
Purpose of the Study:
- To evaluate the long-term outcomes of primary surgical interventions for glaucoma in children following congenital cataract surgery.
- To assess the efficacy of different surgical techniques in reducing intraocular pressure (IOP).
Main Methods:
- Retrospective study of 35 children (37 eyes) with post-congenital cataract glaucoma.
- Inclusion criteria: primary glaucoma surgery between 2011-2021 and at least one-year follow-up.
- Primary outcome: mean IOP reduction measured by Perkins tonometry; follow-up averaged 40.4 months.
Main Results:
- Probe trabeculotomy (n=8) and 360° catheter-assisted trabeculotomy (n=6) significantly reduced IOP after 2 years (p<0.01 and p<0.02).
- Cyclodestructive procedures (n=7) did not show significant IOP reduction after 2 years.
- Both trabeculotomy methods descriptively reduced the need for glaucoma eye drops.
Conclusions:
- Trabeculotomy techniques provide effective IOP reduction in children with glaucoma secondary to congenital cataract surgery.
- Further prospective studies comparing trabeculotomy with glaucoma drainage implants are warranted.
Purpose:
To assess long-time results of primary surgical treatment in children with glaucoma after congenital cataract surgery.
Methods:
A retrospective study of 37 eyes from 35 children with glaucoma after congenital cataract surgery, who underwent surgery between 2011 and 2021 at the Childhood Glaucoma Center, University Medical Center Mainz, Germany. Only children, who received a primary glaucoma surgery in our clinic within the given time (n = 25) and had at least one-year follow-up (n = 21), were included in the further analysis. The mean follow-up time was 40.4±35.1 months. The primary outcome was the mean reduction in IOP (in mmHg) from baseline to follow-up visits after the surgery, measured with Perkins tonometry.
Results:
8 patients (38%) were treated with probe trabeculotomy (probe TO), 6 (29%) with 360° catheter-assisted trabeculotomy (360° TO) and 7 (33%) with cyclodestructive procedures. IOP was significantly reduced after probe TO and 360° TO after 2 years, from 26.9 mmHg to 17.4 mmHg (p<0.01) and 25.2 mmHg to 14.1 mmHg (p<0.02), respectively. There was no significant IOP reduction after cyclodestructive procedures after 2 years. Both, probe TO and 360° TO led descriptively to eye drops reduction after 2 years, from 2.0 to 0.7 and 3.2 to 1.1. The reduction was not significant.
Conclusions:
In glaucoma after congenital cataract surgery, both trabeculotomy techniques, lead to good reduction of IOP after 2 years. There is a need for a prospective study with comparison to the use of glaucoma drainage implants.
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