Launching a paradigm for first and redo-surgery in primary congenital glaucoma: institutional experience
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摘要
AIM: To evaluate the outcome of the initial and the redo-surgeries for primary congenital glaucoma(PCG) correlated to its degree of severity. METHODS: A retrospective study involved patients with PCG presented between 2010 and 2018. Medical records were reviewed to assess the degree of the preoperative severity according to the intraocular pressure(IOP), corneal diameter and corneal edema. Success and failure rates were calculated for both first and redo-surgeries at 6 and 12 mo respectively then correlated to the severity of the cases. RESULTS: Complete records were retrieved for 272 eyes(153 patients) with PCG: 43 eyes were mild, 136 moderate and 93 severe. Combined trabeculotomy and trabeculectomy(CTT) had the highest success rate in moderate(96.4%) and severe cases(59.3%) while trabeculotomy had the highest success rate in mild cases(96.3%). Medical records of 88 eyes(63 patients) with recurrent PCG were analyzed, most with severe presentation(59 eyes). Ahmed glaucoma valve(AGV) was used in 67(76%) eyes and augmented trabeculectomy in 21(24%) eyes. At 12 mo, there was no statistically significant difference between both surgeries in total success rate(P=0.256). For mild cases, success rate was 100% for both surgeries. Severe cases had higher success rates following AGV(87%) than augmented trabeculectomy(20%). Preoperative severity of the disease was an independent factor affecting the failure rate in secondary trabeculectomy but not in AGV. Patients younger than 24 mo had higher probabilities of failure following both redo-surgeries with hazard ratio =1.325 and 0.37 for augmented trabeculectomy and AGV respectively. CONCLUSION: Preoperative assessment of the severity of eyes with PCG helps in the selecting the optimal primary and secondary surgery. For first surgery, trabeculotomy is more effective in mild cases whereas; CTT and augmented subscleral trabeculectomy(SST) are appropriate for moderate and severe cases. AGV proved to be superior to augmented SST in severe recurrent cases.
AIM: To evaluate the outcome of the initial and the redo-surgeries for primary congenital glaucoma(PCG) correlated to its degree of severity. METHODS: A retrospective study involved patients with PCG presented between 2010 and 2018. Medical records were reviewed to assess the degree of the preoperative severity according to the intraocular pressure(IOP), corneal diameter and corneal edema. Success and failure rates were calculated for both first and redo-surgeries at 6 and 12 mo respectively then correlated to the severity of the cases. RESULTS: Complete records were retrieved for 272 eyes(153 patients) with PCG: 43 eyes were mild, 136 moderate and 93 severe. Combined trabeculotomy and trabeculectomy(CTT) had the highest success rate in moderate(96.4%) and severe cases(59.3%) while trabeculotomy had the highest success rate in mild cases(96.3%). Medical records of 88 eyes(63 patients) with recurrent PCG were analyzed, most with severe presentation(59 eyes). Ahmed glaucoma valve(AGV) was used in 67(76%) eyes and augmented trabeculectomy in 21(24%) eyes. At 12 mo, there was no statistically significant difference between both surgeries in total success rate(P=0.256). For mild cases, success rate was 100% for both surgeries. Severe cases had higher success rates following AGV(87%) than augmented trabeculectomy(20%). Preoperative severity of the disease was an independent factor affecting the failure rate in secondary trabeculectomy but not in AGV. Patients younger than 24 mo had higher probabilities of failure following both redo-surgeries with hazard ratio =1.325 and 0.37 for augmented trabeculectomy and AGV respectively. CONCLUSION: Preoperative assessment of the severity of eyes with PCG helps in the selecting the optimal primary and secondary surgery. For first surgery, trabeculotomy is more effective in mild cases whereas; CTT and augmented subscleral trabeculectomy(SST) are appropriate for moderate and severe cases. AGV proved to be superior to augmented SST in severe recurrent cases.
AIM: To evaluate the outcome of the initial and the redo-surgeries for primary congenital glaucoma(PCG) correlated to its degree of severity. METHODS: A retrospective study involved patients with PCG presented between 2010 and 2018. Medical records were reviewed to assess the degree of the preoperative severity according to the intraocular pressure(IOP), corneal diameter and corneal edema. Success and failure rates were calculated for both first and redo-surgeries at 6 and 12 mo respectively then correlated to the severity of the cases. RESULTS: Complete records were retrieved for 272 eyes(153 patients) with PCG: 43 eyes were mild, 136 moderate and 93 severe. Combined trabeculotomy and trabeculectomy(CTT) had the highest success rate in moderate(96.4%) and severe cases(59.3%) while trabeculotomy had the highest success rate in mild cases(96.3%). Medical records of 88 eyes(63 patients) with recurrent PCG were analyzed, most with severe presentation(59 eyes). Ahmed glaucoma valve(AGV) was used in 67(76%) eyes and augmented trabeculectomy in 21(24%) eyes. At 12 mo, there was no statistically significant difference between both surgeries in total success rate(P=0.256). For mild cases, success rate was 100% for both surgeries. Severe cases had higher success rates following AGV(87%) than augmented trabeculectomy(20%). Preoperative severity of the disease was an independent factor affecting the failure rate in secondary trabeculectomy but not in AGV. Patients younger than 24 mo had higher probabilities of failure following both redo-surgeries with hazard ratio =1.325 and 0.37 for augmented trabeculectomy and AGV respectively. CONCLUSION: Preoperative assessment of the severity of eyes with PCG helps in the selecting the optimal primary and secondary surgery. For first surgery, trabeculotomy is more effective in mild cases whereas; CTT and augmented subscleral trabeculectomy(SST) are appropriate for moderate and severe cases. AGV proved to be superior to augmented SST in severe recurrent cases.
引文
1 Kong LK,Fry M,Al-Samarraie M,Gilbert C,Steinkuller PG.An update on progress and the changing epidemiology of causes of childhood blindness worldwide.J AAPOS 2012;16(6):501-507.
2 Moore DB,Tomkins O,Ben-Zion I.A review of primary congenital glaucoma in the developing world.Surv Ophthalmol 2013;58(3):278-285.
3 Yalvac IS,Satana B,Suveren A,Eksioglu U,Duman S.Success of trabeculotomy in patients with congenital glaucoma operated on within 3months of birth.Eye(Lond)2007;21(4):459-464.
4 Mendicino ME,Lynch MG,Drack A,Beck AD,Harbin T,Pollard Z,Vela MA,Lynn MJ.Long-term surgical and visual outcomes in primary congenital glaucoma:360 degrees trabeculotomy versus goniotomy.JAAPOS 2000;4(4):205-210.
5 Khan AO.Trabeculotomy versus trabeculotomy-trabeculectomy for congenital glaucoma.Br J Ophthalmol 2006;90(1):125.
6 Alsheikheh A,Klink J,Klink T,Steffen H,Grehn F.Long-term results of surgery in childhood glaucoma.Graefes Arch Clin Exp Ophthalmol2007;245(2):195-203.
7 Walton DS,Nagao K,Yeung HH,Kane SA.Late-recognized primary congenital glaucoma.J Pediatr Ophthalmol Strabismus 2013;50(4):234-238.
8 Lee N,Ma KT,Bae HW,Hong SM,Seong GJ,Hong YJ,Kim CY.Surgical results of trabeculectomy and Ahmed valve implantation following a previous failed trabeculectomy in primary congenital glaucoma patients.Korean J Ophthalmol 2015;29(2):109-114.
9 Aldohayab S,Morales J,Edward DP,Abu-amero KK.Update on pediatric glaucoma.Semin Ophthalmol 2013;28(3):131-143.
10 Al-Hazmi A,Awad A,Zwaan J,Al-Mesfer SA,Al-Jadaan I,AlMohammed A.Correlation between surgical success rate and severity of congenital glaucoma.Br J Ophthalmol 2005;89(4):449-453.
11 Pakravan M,Homayoon N,Shahin Y,Ali Reza BR.Trabeculectomy with mitomycin C versus Ahmed glaucoma implant with mitomycin C for treatment of pediatric aphakic glaucoma.J Glaucoma 2007;16(7):631-636.
12 Terraciano AJ,Sidoti PA.Management of refractory glaucoma in childhood.Curr Opin Ophthalmol 2002;13(2):97-102.
13 Khan AO.Trabeculotomy versus trabeculotomy-trabeculectomy for congenital glaucoma.Br J Ophthalmol 2006;90(1):125.
14 Mandal AK,Bhatia PG,Gothwal VK,Reddy VM,Sriramulu P,Prasad MS,John RK,Nutheti R,Shamanna BR.Safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma.Indian J Ophthalmol 2002;50(1):13-19.
15 Mandal AK,Matalia JH,Nutheti R,Krishnaiah S.Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14 mm or more.Eye(Lond)2006;20(2):135-143.
16 Meyer G,Schwenn O,Pfeiffer N,Grehn F.Trabeculotomy in congenital glaucoma.Graefes Arch Clin Exp Ophthalmol 2000;238(3):207-213.
17 Onwasigwe EN,Ezegwui IR,Onwasigwe CN,Aghaji AE.Management of primary congenital glaucoma by trabeculectomy in Nigeria.Ann Trop Paediatr 2008;28(1):49-52.
18 Rodrigues AM,Júnior AP,Montezano FT,de Arruda Melo PA,Prata JJr.Comparison between results of trabeculectomy in primary congenital glaucoma with and without the use of mitomycin C.J Glaucoma2004;13(3):228-232.
19 Fulcher T,Chan J,Lanigan B,Bowell R,O’Keefe M.Long-term follow up of primary trabeculectomy for infantile glaucoma.Br JOphthalmol 1996;80(6):499-502.
20 Morad Y,Donaldson CE,Kim YM,Abdolell M,Levin AV.The Ahmed drainage implant in the treatment of pediatric glaucoma.Am J Ophthalmol2003;135(6):821-829.
21 O’Malley Schotthoefer E,Yanovitch TL,Freedman SF.Aqueous drainage device surgery in refractory pediatric glaucomas:I.Long-term outcomes.J AAPOS 2008;12(1):33-39.
22 Ou Y,Yu F,Law SK,Coleman AL,Caprioli J.Outcomes of Ahmed glaucoma valve implantation in children with primary congenital glaucoma.Arch Ophthalmol 2009;127(11):1436-1441.
23 Djodeyre MR,Peralta Calvo J,Abelairas Gomez J.Clinical evaluation and risk factors of time to failure of Ahmed Glaucoma Valve implant in pediatric patients.Ophthalmology 2001;108(3):614-620.
24 Beck AD,Freedman S,Kammer J,Jin J.Aqueous shunt devices compared with trabeculectomy with Mitomycin-C for children in the first two years of life.Am J Ophthalmol 2003;136(6):994-1000.
25 Hill R,Ohanesian R,Voskanyan L,Malayan A.The Armenian Eye Care Project:surgical outcomes of complicated paediatric glaucoma.Br JOphthalmol 2003;87(6):673-676.
26 Chen A,Yu F,Law SK,Giaconi JA,Coleman AL,Caprioli J.Valved glaucoma drainage devices in pediatric glaucoma:retrospective long-term outcomes.JAMA Ophthalmol 2015;133(9):1030-1035.
27 Dada T,Kusumesh R,Bali SJ,Sharma S,Sobti A,Arora V,Panda A.Trabeculectomy with combined use of subconjunctival collagen implant and low-dose mitomycin C.J Glaucoma 2013;22(8):659-662.
28 Min JK,Kee CW,Sohn SW,Lee HJ,Woo JM,Yim JH.Surgical outcome of mitomycin C-soaked collagen matrix implant in trabeculectomy.J Glaucoma 2013;22(6):456-462.
29 Dave P,Senthil S,Choudhari N,Sekhar GC.Outcomes of Ahmed valve implant following a failed initial trabeculotomy and trabeculectomy in refractory primary congenital glaucoma.Middle East Afr J Ophthalmol2015;22(1):64-68.
30 Ishida K,Mandal AK,Netland PA.Glaucoma drainage implants in pediatric patients.Ophthalmol Clin North Am 2005;18(3):431-442,vii.
31 Kuchar S,Moster MR,Reamer CB,Waisbourd M.Treatment outcomes of micropulse transscleral cyclophotocoagulation in advanced glaucoma.Lasers Med Sci 2016;31(2):393-396.
2 Moore DB,Tomkins O,Ben-Zion I.A review of primary congenital glaucoma in the developing world.Surv Ophthalmol 2013;58(3):278-285.
3 Yalvac IS,Satana B,Suveren A,Eksioglu U,Duman S.Success of trabeculotomy in patients with congenital glaucoma operated on within 3months of birth.Eye(Lond)2007;21(4):459-464.
4 Mendicino ME,Lynch MG,Drack A,Beck AD,Harbin T,Pollard Z,Vela MA,Lynn MJ.Long-term surgical and visual outcomes in primary congenital glaucoma:360 degrees trabeculotomy versus goniotomy.JAAPOS 2000;4(4):205-210.
5 Khan AO.Trabeculotomy versus trabeculotomy-trabeculectomy for congenital glaucoma.Br J Ophthalmol 2006;90(1):125.
6 Alsheikheh A,Klink J,Klink T,Steffen H,Grehn F.Long-term results of surgery in childhood glaucoma.Graefes Arch Clin Exp Ophthalmol2007;245(2):195-203.
7 Walton DS,Nagao K,Yeung HH,Kane SA.Late-recognized primary congenital glaucoma.J Pediatr Ophthalmol Strabismus 2013;50(4):234-238.
8 Lee N,Ma KT,Bae HW,Hong SM,Seong GJ,Hong YJ,Kim CY.Surgical results of trabeculectomy and Ahmed valve implantation following a previous failed trabeculectomy in primary congenital glaucoma patients.Korean J Ophthalmol 2015;29(2):109-114.
9 Aldohayab S,Morales J,Edward DP,Abu-amero KK.Update on pediatric glaucoma.Semin Ophthalmol 2013;28(3):131-143.
10 Al-Hazmi A,Awad A,Zwaan J,Al-Mesfer SA,Al-Jadaan I,AlMohammed A.Correlation between surgical success rate and severity of congenital glaucoma.Br J Ophthalmol 2005;89(4):449-453.
11 Pakravan M,Homayoon N,Shahin Y,Ali Reza BR.Trabeculectomy with mitomycin C versus Ahmed glaucoma implant with mitomycin C for treatment of pediatric aphakic glaucoma.J Glaucoma 2007;16(7):631-636.
12 Terraciano AJ,Sidoti PA.Management of refractory glaucoma in childhood.Curr Opin Ophthalmol 2002;13(2):97-102.
13 Khan AO.Trabeculotomy versus trabeculotomy-trabeculectomy for congenital glaucoma.Br J Ophthalmol 2006;90(1):125.
14 Mandal AK,Bhatia PG,Gothwal VK,Reddy VM,Sriramulu P,Prasad MS,John RK,Nutheti R,Shamanna BR.Safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma.Indian J Ophthalmol 2002;50(1):13-19.
15 Mandal AK,Matalia JH,Nutheti R,Krishnaiah S.Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14 mm or more.Eye(Lond)2006;20(2):135-143.
16 Meyer G,Schwenn O,Pfeiffer N,Grehn F.Trabeculotomy in congenital glaucoma.Graefes Arch Clin Exp Ophthalmol 2000;238(3):207-213.
17 Onwasigwe EN,Ezegwui IR,Onwasigwe CN,Aghaji AE.Management of primary congenital glaucoma by trabeculectomy in Nigeria.Ann Trop Paediatr 2008;28(1):49-52.
18 Rodrigues AM,Júnior AP,Montezano FT,de Arruda Melo PA,Prata JJr.Comparison between results of trabeculectomy in primary congenital glaucoma with and without the use of mitomycin C.J Glaucoma2004;13(3):228-232.
19 Fulcher T,Chan J,Lanigan B,Bowell R,O’Keefe M.Long-term follow up of primary trabeculectomy for infantile glaucoma.Br JOphthalmol 1996;80(6):499-502.
20 Morad Y,Donaldson CE,Kim YM,Abdolell M,Levin AV.The Ahmed drainage implant in the treatment of pediatric glaucoma.Am J Ophthalmol2003;135(6):821-829.
21 O’Malley Schotthoefer E,Yanovitch TL,Freedman SF.Aqueous drainage device surgery in refractory pediatric glaucomas:I.Long-term outcomes.J AAPOS 2008;12(1):33-39.
22 Ou Y,Yu F,Law SK,Coleman AL,Caprioli J.Outcomes of Ahmed glaucoma valve implantation in children with primary congenital glaucoma.Arch Ophthalmol 2009;127(11):1436-1441.
23 Djodeyre MR,Peralta Calvo J,Abelairas Gomez J.Clinical evaluation and risk factors of time to failure of Ahmed Glaucoma Valve implant in pediatric patients.Ophthalmology 2001;108(3):614-620.
24 Beck AD,Freedman S,Kammer J,Jin J.Aqueous shunt devices compared with trabeculectomy with Mitomycin-C for children in the first two years of life.Am J Ophthalmol 2003;136(6):994-1000.
25 Hill R,Ohanesian R,Voskanyan L,Malayan A.The Armenian Eye Care Project:surgical outcomes of complicated paediatric glaucoma.Br JOphthalmol 2003;87(6):673-676.
26 Chen A,Yu F,Law SK,Giaconi JA,Coleman AL,Caprioli J.Valved glaucoma drainage devices in pediatric glaucoma:retrospective long-term outcomes.JAMA Ophthalmol 2015;133(9):1030-1035.
27 Dada T,Kusumesh R,Bali SJ,Sharma S,Sobti A,Arora V,Panda A.Trabeculectomy with combined use of subconjunctival collagen implant and low-dose mitomycin C.J Glaucoma 2013;22(8):659-662.
28 Min JK,Kee CW,Sohn SW,Lee HJ,Woo JM,Yim JH.Surgical outcome of mitomycin C-soaked collagen matrix implant in trabeculectomy.J Glaucoma 2013;22(6):456-462.
29 Dave P,Senthil S,Choudhari N,Sekhar GC.Outcomes of Ahmed valve implant following a failed initial trabeculotomy and trabeculectomy in refractory primary congenital glaucoma.Middle East Afr J Ophthalmol2015;22(1):64-68.
30 Ishida K,Mandal AK,Netland PA.Glaucoma drainage implants in pediatric patients.Ophthalmol Clin North Am 2005;18(3):431-442,vii.
31 Kuchar S,Moster MR,Reamer CB,Waisbourd M.Treatment outcomes of micropulse transscleral cyclophotocoagulation in advanced glaucoma.Lasers Med Sci 2016;31(2):393-396.