Pediatric Glaucoma Surgery Demonstrates Long-Term Success

Esther Hoffman, PhD

Surgical interventions in children with congenital and secondary glaucoma were associated with long-term success rates, according to findings from a retrospective cohort study.

A team led by Esther Hoffman, PhD, of the Childhood Glaucoma Center in University Medical Center Mainz, Germany, evaluated patients who had received first-time glaucoma surgery with 1 year of follow-up data.

“Surgery is challenging and follow-up over lifetime is demanding, including amblyopia prevention, regular measurement of intraocular pressure (IOP), and examinations under general anesthesia in babies,” Hoffman and team wrote. Even more, the practice requires utilization of an interdisciplinary care team.

The Study

The investigators analyzed data of 79 eyes from 52 patients aged 18 years or younger (range, 3 weeks – 15.3 years). All patients were treated between 2015 – 2017, and had a median follow-up time of 3.9 years.

Hoffman’s team compared surgical techniques, including conventional probe trabeculotomy, 360° catheter-assisted trabeculotomy, filtering and cyclodestructive surgery.

Measurements of IOP in all eyes, made according to hand-held Perkins applanation and ICare-tonometer, were recorded following induction and maintenance of general anesthesia. Axial length was measured by ultrasonography with Tomey-AL-2000, and the corneal diameter of the eye was measured by a caliper.

The investigators defined surgical success as demonstrating an IOP of 5–17 mmHg after a minimum of 12 months post-surgery. Patients were able to utilize topical medications as therapy; however, there must have been no additional surgical intervention in that same time frame.

Incomplete surgical success was defined as having an IOP of 5-17 mmHg with further surgical intervention within the year.

As such, the main outcome sought by the investigators was surgical success, with secondary outcomes being the development of intraocular pressure over time, visual acuity, refraction, corneal diameter, and axial length development in both eyes.

The Results

As many as 39 eyes (54.2%) achieved an IOP of 17 mmHg or less without the need for surgical intervention by 1-year follow-up. However, up to 67 eyes (90.5%) achieved an IOP of 17 mmHg or below, including those that achieved incomplete surgical success.

The investigators noted that IOP was significantly reduced among patients with primary congenital glaucoma (preoperative IOP, 27.8 mmHg vs postoperative IOP, 14.2 mmHg) and secondary glaucoma (preoperative IOP, 29.2, mmHg vs postoperative IOP, 16.6 mmHg).

There was no statistically significant difference between the groups.

Axial length differences to age-matched normative values decreased from +3.91 at baseline to +3.42 at follow-up—both of which were considered a significant deviation from normal. However, the pre-operative to post-operative decrease in deviation was not considered significant.

Corneal diameter achieved a statistically significant decrease in deviation from normal (pre-operative, +3.15 vs post-operative, +2.84; P = .036). Visual acuity, assessed in 37% of all eyes, slightly increased from a mean of -0.71 LogMAR to -0.67 LogMAR.

Further, Hoffman and team found 360° catheter-assisted trabeculotomy had the best success rates, followed by probe trabeculotomy and filtering surgery (Ahmed-valve implantation, trabeculectomy, and combined trabeculectomy/trabeculotomy). Cyclodestructive procedures (controlled photocoagulation and cyclocryocoagualation) had the lowest success rates.

Probe trabeculotomy was the most common used surgical intervention used among these patients.

Final Thoughts

“In conclusion, we found very promising surgical results in our childhood glaucoma patient group,” the investigators wrote.

“Although our study includes heterogeneous data on primary and secondary childhood glaucoma, we believe this reflects the reality of a large childhood glaucoma center,” they continued.

They lauded 360° trabeculotomy as their preferred treatment option, while acknowledging that further evaluations of the treatment and comparisons with probe trabeculotomy are warranted.

The study, “Results of childhood glaucoma surgery over a long-term period,” was published online in Acta Ophthalmologica.