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Surgical results of secondary glaucomas in childhood
D K Wallace1, D A Plager, S K Snyder
1Department of Ophthalmology, University of North Carolina at Chapel Hill, USA.
Objective:
This study aimed to describe results of glaucoma surgeries performed at one institution over the past 20 years in children with aphakia, aniridia, anterior segment dysgenesis, and other secondary glaucomas.
Design:
The study design was a retrospective review.
Participants:
Fifty-eight eyes of 40 patients were studied.
Intervention:
Trabeculectomy with or without mitomycin C, Molteno implantation, goniotomy, sclerostomy, endolaser cyclophotocoagulation, and cyclocryotherapy were performed.
Main Outcome Measures:
Intraocular pressure (IOP) control, defined as complete success (IOP < or = 21 without medications) or qualified success (IOP < or = 25 without medications or IOP < or = 21 with medications) and postoperative visual acuity stability were assessed.
Results:
One hundred thirty surgical procedures were performed on 58 eyes of 40 patients; follow-up averaged 7.3 years. Intraocular pressure control was achieved in 40 (70%) of 57 eyes after 1 or more procedures. Intraocular pressure control and stabilization of visual acuity and optic disc appearance were achieved in 28 (51%) of 55 eyes. Five eyes had significant postoperative complications. Trabeculectomy with mitomycin C controlled IOP on last visit in 8 of 13 eyes with aphakic glaucoma.
Conclusions:
Surgical intervention can control IOP and prevent visual loss in children with secondary glaucomas. In the authors' experience, a filtering procedure is the most effective treatment in aphakic glaucoma and anterior segment dysgenesis.