Long-term Visual Acuity Outcomes of Deep Sclerectomy in Pediatric Glaucoma

This study provides evidence of the long-term efficacy and safety of deep sclerectomy as a successful surgical intervention option in cases with childhood glaucoma.

The primary objective was to evaluate the long-term visual acuity outcomes of deep sclerectomy in pediatric glaucoma and identify factors predicting poor prognosis. The secondary objective was to evaluate the long-term success rate of deep sclerectomy in controlling intraocular pressure (IOP).

A retrospective review was conducted of all pediatric patients who underwent deep sclerectomy at King Abdulaziz University Hospital (KAUH) between 2001 and 2016. We included all patients who had valid visual acuity tests. The preoperative findings and long-term visual and IOP outcomes were analyzed.

A total of 83 eyes of 68 patients were included. The mean (SD) age of participants was 11.1 (4.0) years (range: 5-25 y). The mean age at surgery was 5.9 months, and the mean follow-up period was 10.75 years. The majority of cases (83.1%) were primary congenital glaucoma. Visual acuity was ≥20/40 in 56.6% of cases, ranged between 20/40 and 20/200 in 18.1%, and was ≤20/200 in 25.3% of the operated eyes. Complete success rate (IOP ≤21 mm Hg without medications) after one surgery was achieved in 53 eyes (63.86%). Qualified success rate (IOP ≤21 mm Hg with medications) was achieved in 8 eyes (9.6%), while 22 eyes (26.5%) failed to achieve the target IOP of ≤21 mm Hg or needed additional surgery to achieve it. Nine eyes (10.74%) had postoperative complications.

Deep sclerectomy is a reasonable option for pediatric glaucoma that can provide good long-term visual outcomes and IOP control with a lower risk of surgical complications.