Surgery for glaucoma in patients with facial port wine mark

Abstract

To report the results of surgical treatment of glaucoma in patients with facial port wine mark at a single institution over a 10-year period. The study was conducted on 21 eyes (10 right eyes) of 17 children (8 males) with glaucoma associated with facial port wine mark presenting to the pediatric ophthalmology practice at a single institution between January 2008 and December 2017. All study eyes underwent combined angle and filtering surgery with antimetabolite (mitomycin C) and were followed for 2years. Eyes were randomized for the angle component of the procedure to conventional trabeculotomy-trabeculectomy (CTT) or viscotrabeculotomy-trabeculectomy (VTT). Success was defined as intraocular pressure (IOP) of 5-16mm Hg with no vision-threatening complications. Mean patient age was 17.4±7.5months. Mean IOP was 30.4±3.7mm Hg; mean corneal diameter, 12.4±0.5mm; mean axial length, 21.17±1.63mm; mean cup:disk ratio, 0.5±0.2; and mean number of IOP-lowering drugs at presentation, 2.6±0.5. At the end of the 2-year follow-up period, corresponding values were 12.9±0.9mm Hg, 12.6±0.4mm, 21.6±1.7mm, 0.6±0.2, and 0.1±0.3, respectively, in VTT patients and 14.3±0.7mm Hg, 12.9±0.5mm, 21.8±1.7mm, 0.6±0.2, and 0.1±0.4, respectively, in CTT groups. The most notable complication was a minimal self-limiting hyphema, more prevalent in the CTT group. In our study cohort, there were few postoperative complications associated with combined angle and filtering surgery with antimetabolites, which effectively treated elevated IOP, especially when medical treatment showed a modest response. The addition of viscoelastic to the procedure may provide additional benefits and slightly limit intra- and postoperative complications.