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A Survey of the Congenital Glaucoma Surgery Practice Patterns in the Indian Pediatric Glaucoma Society
Anil K Mandal1, Zayn Al-Timimi2,3, Vijaya K Gothwal3,4,5
1VST Center for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, India.
Insights
Pediatric glaucoma management shows consensus, but some practices like mitomycin-C use vary among Indian specialists. This survey offers a baseline for future trends in primary congenital glaucoma care.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Glaucoma Research
Background:
- Primary congenital glaucoma (PCG) requires specialized management in children.
- Understanding current practice patterns is crucial for improving PCG care.
- The Indian Pediatric Glaucoma Society (IPGS) comprises specialists in this field.
Purpose of the Study:
- To assess the current practice patterns of Indian Pediatric Glaucoma Society (IPGS) members in managing children with primary congenital glaucoma (PCG).
Main Methods:
- An anonymous online survey with 74 questions was distributed to 88 IPGS members.
- The survey covered demographics, training, clinic details, surgical preferences, and follow-up practices.
- Data were analyzed using descriptive statistics and Chi-square tests, with significance set at p < 0.05.
Main Results:
- A high response rate of 82% (71 respondents) was achieved.
- Most respondents (69%) had specialized pediatric glaucoma fellowship training, significantly more than those with general pediatric ophthalmology fellowship training (11%).
- Combined trabeculotomy-trabeculectomy was common for hazy corneas (95%), while goniotomy was preferred for clear corneas (49%). Surgical approaches for bilateral involvement and mitomycin-C use showed diversity. Patient-related factors like delayed presentation and socioeconomic status were key challenges.
Conclusions:
- While consensus exists in many PCG management areas, variations in specific practices, such as mitomycin-C use in primary surgery, were observed.
- This survey provides valuable insights into current clinical practices among Indian pediatric glaucoma specialists.
- The findings establish a baseline for monitoring future trends in PCG management and identifying areas for further standardization or research.
Purpose:
To assess the practice patterns among the Indian Pediatric Glaucoma Society (IPGS) members in the management of children with primary congenital glaucoma (PCG).
Methods:
An anonymous 74-question survey was administered online via Qualtrics (Qualtrics, Provo, Utah, USA) using a link sent by email to the 88 IPGS members. The questionnaire comprised five sections and was designed to gather information regarding respondent demographics and specialty training, clinic composition and volume, surgical practices and preferences, follow-up practices, and additional services. The survey was closed after 10 weeks. Data were analyzed using descriptive statistics and Chi-square tests. Statistical significance was set at p < .05.
Results:
The response rate was 82%. Of the 71 respondents, 49 (69%) reported possessing glaucoma fellowship training that included specialist training in pediatric glaucoma. By comparison, 8 respondents (11%) reported possessing pediatric ophthalmology fellowship training that included specialist training in pediatric glaucoma, and this difference was statistically significant (69% vs. 11%; χ2 = 47.37; p < .0001). The majority of the respondents were in ophthalmic institution-based practice (83%) and were located in South India (58%). In cases of hazy cornea, the most common surgery (95%) performed was combined trabeculotomy-trabeculectomy while goniotomy was most preferred (49%) in cases of clear cornea. Approximately, one-half of the respondents (56%) preferred to operate on each eye in separate sessions, whereas 46% preferred to operate on both eyes in the same session. One-half of the respondents (51%) preferred to use mitomycin-C in primary surgery. The most common challenges in providing care were patient-related, including delayed presentation, high travel costs, and low socioeconomic status.
Conclusions:
Although a substantial consensus was found in most areas of management, a few areas, for example, use of MMC in primary surgery, showed diversity. The information gathered will enable glaucomatologists to compare their practices with those of their colleagues. In addition, this survey provides a baseline, allowing future trends in management to be determined.
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