The role of goniotomy in the management of aphakic glaucoma—extended follow-up

Abstract

IntroductionWe wished to determine the role of goniotomy in cases with aphakic glaucoma after congenital cataract surgery.MethodsRetrospective case note review of patients with aphakic glaucoma undergoing goniotomy between Sept 1999 and Sept 2008.ResultsWe identified 6 patients (8 eyes) who underwent 12 goniotomies (10 temporal approach goniotomies (TAG), 2 nasal approach goniotomies (NAG)). All patients underwent lensectomy without intraocular lens implant. All 8 eyes had anomalous angle on gonioscopy. Median age at cataract surgery was 2 months (range, 0.75-3 months). There were 4 patients (4 eyes) with unilateral cataract with persistent fetal vasculature (PFV), 2 patients (4 eyes) with bilateral cataract. Median age at presentation of glaucoma was 4 months (range 1.5-20 months). Median time of follow-up after last goniotomy was 68.5 months (range 23-114 months). 4/8 eyes (all with PFV) underwent 1-3 cyclodiode treatments before TAG or NAG. 6 of 8 eyes (75%) were controlled with no sign of glaucoma progression with/without topical treatment by 1 or 3 goniotomies. 2 of 8 eyes required multiple cyclodiode lasers after last goniotomy was performed to control glaucoma. 1 of 8 eyes had developed rhegmatogenous retinal detachment 23 months after NAG. No eye developed hyphaema that needed evacuation.DiscussionIn this small series 75% of eyes had controlled glaucoma with/without drops by goniotomy/-ies and were spared from filtration/seton surgery.ConclusionsGoniotomy should be considered as a treatment option in cases of aphakic glaucoma when gonioscopy shows an abnormality of the angle, especially in cases of PFV. IntroductionWe wished to determine the role of goniotomy in cases with aphakic glaucoma after congenital cataract surgery. We wished to determine the role of goniotomy in cases with aphakic glaucoma after congenital cataract surgery. MethodsRetrospective case note review of patients with aphakic glaucoma undergoing goniotomy between Sept 1999 and Sept 2008. Retrospective case note review of patients with aphakic glaucoma undergoing goniotomy between Sept 1999 and Sept 2008. ResultsWe identified 6 patients (8 eyes) who underwent 12 goniotomies (10 temporal approach goniotomies (TAG), 2 nasal approach goniotomies (NAG)). All patients underwent lensectomy without intraocular lens implant. All 8 eyes had anomalous angle on gonioscopy. Median age at cataract surgery was 2 months (range, 0.75-3 months). There were 4 patients (4 eyes) with unilateral cataract with persistent fetal vasculature (PFV), 2 patients (4 eyes) with bilateral cataract. Median age at presentation of glaucoma was 4 months (range 1.5-20 months). Median time of follow-up after last goniotomy was 68.5 months (range 23-114 months). 4/8 eyes (all with PFV) underwent 1-3 cyclodiode treatments before TAG or NAG. 6 of 8 eyes (75%) were controlled with no sign of glaucoma progression with/without topical treatment by 1 or 3 goniotomies. 2 of 8 eyes required multiple cyclodiode lasers after last goniotomy was performed to control glaucoma. 1 of 8 eyes had developed rhegmatogenous retinal detachment 23 months after NAG. No eye developed hyphaema that needed evacuation. We identified 6 patients (8 eyes) who underwent 12 goniotomies (10 temporal approach goniotomies (TAG), 2 nasal approach goniotomies (NAG)). All patients underwent lensectomy without intraocular lens implant. All 8 eyes had anomalous angle on gonioscopy. Median age at cataract surgery was 2 months (range, 0.75-3 months). There were 4 patients (4 eyes) with unilateral cataract with persistent fetal vasculature (PFV), 2 patients (4 eyes) with bilateral cataract. Median age at presentation of glaucoma was 4 months (range 1.5-20 months). Median time of follow-up after last goniotomy was 68.5 months (range 23-114 months). 4/8 eyes (all with PFV) underwent 1-3 cyclodiode treatments before TAG or NAG. 6 of 8 eyes (75%) were controlled with no sign of glaucoma progression with/without topical treatment by 1 or 3 goniotomies. 2 of 8 eyes required multiple cyclodiode lasers after last goniotomy was performed to control glaucoma. 1 of 8 eyes had developed rhegmatogenous retinal detachment 23 months after NAG. No eye developed hyphaema that needed evacuation. DiscussionIn this small series 75% of eyes had controlled glaucoma with/without drops by goniotomy/-ies and were spared from filtration/seton surgery. In this small series 75% of eyes had controlled glaucoma with/without drops by goniotomy/-ies and were spared from filtration/seton surgery. ConclusionsGoniotomy should be considered as a treatment option in cases of aphakic glaucoma when gonioscopy shows an abnormality of the angle, especially in cases of PFV. Goniotomy should be considered as a treatment option in cases of aphakic glaucoma when gonioscopy shows an abnormality of the angle, especially in cases of PFV.