Abstract
Glaucoma is a common and sight-threatening complication of pediatric cataract surgery Reported incidence varies due to variability in study designs and length of follow-up. Consistent and replicable risk factors for developing glaucoma following cataract surgery (GFCS) are early age at the time of surgery, microcornea, and additional surgical interventions. The exact mechanism for GFCS has yet to be completely elucidated. While medical therapy is the first line for treatment of GFCS, many eyes require surgical intervention, with various surgical modalities each posing a unique host of risks and benefits. Angle surgical techniques include goniotomy and trabeculotomy, with trabeculotomy demonstrating increased success over goniotomy as an initial procedure in pediatric eyes with GFCS given the success demonstrated throughout the literature in reducing IOP and number of IOP-lowering medications required post-operatively. The advent of microcatheter facilitated circumferential trabeculotomies lead to increased success compared to traditional <180° rigid probe trabeculotomy in GFCS. The advent of two-site rigid-probe trabeculotomy indicated that similar results could be attained without the use of the more expensive microcatheter system. Further studies of larger scale, with increased follow-up, and utilizing randomization would be beneficial in determining optimum surgical management of pediatric GFCS.
Highlights
The higher rates of survival seen in 360◦ microcatheter canalization suggest that this method of trabeculotomy yields greater success in intra-ocular pressure (IOP) control in pediatric glaucoma, but greater study is needed in glaucoma following cataract surgery (GFCS) eyes to determine whether this can be said to be true amongst this sub-population of pediatric glaucomatous eyes
One eye experienced vitreous hemorrhage requiring pars plana vitrectomy, and another eye had progressive myopic shift requiring IOL exchange. These results indicate that two-site trabeculotomy is a safe, efficacious, and more cost-effective method for IOP control in GFCS with decreased risk of manipulation of potential future sites of glaucoma surgery
Glaucoma is an insidious disease entity that remains a complication after pediatric cataract surgery [1]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. While the mechanism for GFCS has yet to be completely elucidated, prior studies have implicated post-operative trabecular meshwork (TM) obstruction caused by both anterior repositioning of the iris and residual lens material, as well as synechiae formation, reduction in the diameter of Schlemm’s canal, and anterior chamber angle narrowing [3,4,5,6] These factors contribute to an increase in intra-ocular pressure (IOP). After cataract surgery, not uncommonly leading to ocular hypertension (OHTN) and, in some cases, glaucoma [7,8] The incidence of such occurrences varies throughout the literature from 15% to 45%, likely due to differences in study design, variability in age at time of surgery, sample size, and length of post-operative follow-up [9,10,11]. The focus of this review is to outline the current literature on surgical methods and outcomes in angle surgery for pediatric GFCS to aid in management of such an insidious and sight-threatening disease entity
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
