Surgical Treatment Of Congenital Glaucoma Research Articles

Influence of various factors on the efficiency of trabeculectomy in pediatric patients with congenital glaucoma

AIM: The study aimed to analyze the influence of various factors on the efficiency of trabeculectomy in pediatric patients with congenital glaucoma. MATERIAL AND METHODS: The results of 945 trabeculectomies, including those with various modifications and the use of drains, in pediatric patients with congenital glaucoma were analyzed in the Department of Pediatric Eye Pathology of the Helmholtz National Medical Research Center for Eye Diseases for 1997–2023. RESULTS: The efficiency of trabeculectomy in pediatric patients with congenital glaucoma was 91.9%–98.5% in the immediate period (up to 6 months) after surgery, 75.5%–86.5% in the long term (after 5 years), and 34.2%–42.1% with repeated surgeries (up to 3–4 surgeries) during follow-up up to 10 years, which is comparable with literature data. CONCLUSION: The main factors that influence the efficiency of trabeculectomy in pediatric patients with congenital glaucoma include age at the time of detection and surgical treatment of congenital glaucoma, their somatic health, glaucoma stage, and severity of destructive changes in the eye, particularly the congenital ones, presence of repeated surgeries, erroneous choice of the trabecular site subject to excision during surgery, injury rate of trabeculectomy (quality of incision of the conjunctiva, sclera, injury rate of vessel coagulation during surgery, and skill of the surgeon), presence of intra- and postoperative complications, untimely detection and YAG laser elimination of the internal fistula fusion after trabeculectomy, and inadequate management of the postoperative period.

Комбинированное оперативное вмешательство при врожденных глаукомах у детей с сочетанной патологией хрусталика

In recent years, the percentage of early manifestations of congenital glaucoma in children with anomalies of the anterior segment of the eye has increased. The tactics of surgical treatment of this form of glaucoma, especially with combined pathology of the lens, is an urgent problem in pediatric ophthalmic surgery. Purpose. To determine the optimal tactics and analyze the results of surgical treatment of congenital glaucoma in eyes with anomalies of the anterior segment of the eye, combined with abnormalities of the lens development. Material and methods. For 2018–2023 we operated on 27 people (43 eyes) with congenital glaucoma in eyes with concomitant congenital lens pathology. All children underwent combined surgical interventions (vitreal and anthralaucomatous surgery) in one or more stages. Results. As a result of surgical treatment, a positive effect on IOP compensation was achieved in 88,4 % of cases (38 eyes). Conclusions. In case of pathology of the anterior segment of the eye in combination with pathology of the lens, surgical intervention is necessary in the early stages of identifying Intraocular pressure decompensation. Сombined operations are effective: vitreal surgery (reconstructive surgery on the anterior segment) and antiglaucomatous operations of the fistulizing type. Keywords: congenital glaucoma, congenital lens pathology, combined operations

Importance of parental compliance in postoperative rehabilitation of children with glaucoma

This study assesses the level of parental compliance with rehabilitation measures and attempts to identify the factors affecting it during the rehabilitation period of children after surgical treatment of congenital glaucoma. The study was conducted through a survey involving 62 parents of children who underwent surgical treatment for glaucoma at the ophthalmology department of the Tashkent Pediatric Medical Institute. Parents were provided with a link to the online survey after giving their consent. The questionnaire consisted of eight questions with multiple-choice answers. Analysis of the answers showed the following trends: the majority of parents had either a secondary or vocational education (59.7%); most parents lived in rural areas (64.5%); a significant portion had partial or no knowledge about the course and outcomes of glaucoma (51.6%); unreliable sources for information (45.2%); irregular adherence to the doctor's recommendations (29%); significant difficulties in following the prescribed recommendations (64.5%). It was found that the level of parental compliance with rehabilitation measures is low in a significant portion of families (37.2%) with children who underwent surgery for glaucoma. The main factors contributing to poor parental compliance include living in rural areas, insufficient knowledge about the disease, lack of strict adherence to medical recommendations, and various difficulties in implementing the prescribed recommendations (p<0.05).

Результаты хирургического лечения врожденной глаукомы с применением дренажа глаутекс

Результаты хирургического лечения врожденной глаукомы с применением дренажа глаутекс

Surgical treatment of congenital glaucoma in children using Glautex drainage

Clinical studies were conducted in the ophthalmological department of Tashkent Pediatric Medical Institute clinic. The study included 47 patients (50 eyes) with congenital glaucoma. All children had undergone anti-glaucomatous surgery previously. Patients were divided into 2 groups. Patients of group 1 underwent a fistulizing antiglaucomatous operation using autoscleral drainage, and group 2 - sinus trabeculectomy with the use of Glautex biodegradable drainage. Analysis of the obtained data showed that IOP in patients of group 1 averaged 14.8±0.08 mm Hg on day 7 (at discharge), 21.3±0.07 mm Hg after 1 month, 22.7±0.07 mm Hg after 3 months, and 22.9±0.01 mm Hg after 6 months. IOP of group 2 patients amounted to 17.8±0.03 mm Hg at discharge, 18.3±0.07 mm Hg after 1 month, 18.8±0.08 mm Hg after 3 months, and 19.1±0.07 mm Hg after 6 months. In patients of group 1, the true P0 level decreased by 41% and amounted to 13.5 mm Hg, while in patients of group 2 it decreased by 52.7% and averaged 11.2 mm Hg. Sinus trabeculectomy using Glautex drainage can help achieve a long hypotensive effect, avoid repeated surgical interventions, prevent severe postoperative hypotension and thereby reduce the risk of postoperative complications.

Временный «жидкий» имплантат при врожденной глаукоме (отдаленные результаты)

The aim of the work was to analyze the long-term results of using a temporary “liquid” implant in the surgery of congenital glaucoma in children. The basis of the developed method of filtrative antiglaucomatous surgery (Patent of Ukraine No. 45099 of 2009) – viscosinusotrabeculotomy – has been set the task of reducing the risk of developing intra- and postoperative complications, reducing the scarring rate and maintaining the newly created ways of the intraocular fluid outflow, which in general will increase the effectiveness of surgical treatment of congenital glaucoma in children. 54 children (91 eyes) with simple congenital glaucoma at the age of 1 to 36 months were operated on average (8.7 ± 8.2) months. The persistent and long-lasting hypotensive effect achieved due to viscosinusotrabeculotomy in children with developed and far-advanced stages of congenital glaucoma stops the processes of stretching of the membranes of the eye and stabilizes their size, which in general allows preserving and visual functions improving, in infancy – creating conditions for their formation.

Trabeculectomy with Ologen implant versus mitomycin C in congenital glaucoma secondary to Sturge Weber Syndrome.

To compare the efficacy and safety of collagen matrix implant [Ologen (OLO) implant] versus mitomycin C (MMC) with subscleral trabeculectomy (SST) for the surgical treatment of congenital glaucoma (CG) in Sturge-Weber Syndrome (SWS). A prospective comparative randomized study of 20 eyes of 16 patients with CG associated with SWS was divided into two groups. The first group (MMC Group) included 10 eyes that were subjected to SST with MMC. The second group (OLO Group) included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant (OLO implant). Postoperative evaluation included intraocular pressure (IOP) level, bleb evaluation, complications, and the need for further medication or surgical intervention. The mean preoperative IOP was 29±3.16 mm Hg in MMC and 29.8±3.08 mm Hg in OLO eyes. Mean 12-month percentage reduction in IOP was significant in both groups (57.9% and 56.3%). At the end of the 12 postoperative follow-up month, in the MMC Group, 80% of eyes achieved the complete success, 20% of eyes had qualified success with no failed surgery in comparison to OLO Group which 70% of eyes achieved the complete success, 20% of eyes had qualified success with 10% failed surgery. In terms of complications, the MMC Group had a higher rate of complications than the OLO Group in the form of thin polycystic bleb in 6 eyes (60%), blebitis in only one eye (10%) treated with topical antibiotics, shallow anterior chamber in two eyes (20%). This study proves that the use of a collagen matrix implant yields equally effective results as MMC when combined with trabeculectomy for the treatment of CG in SWS. Furthermore, OLO implantation is safe and has low incidences of complications.

Surgical treatment of congenital glaucoma

Congenital glaucoma is a type of disease which may seriously affect children's visual function. Different from adult glaucoma, medical therapy has a limited role and surgery remains the primary therapy. There are several types of surgical treatments for different patient. With the development of technology, more innovation surgeries, such as Trabectome(TM) and 360-degree suture trabeculotomy, are used in the treatment of congenital glaucoma with good result. At the same time, endoscopic technique is used in classical surgeries to break through their original limitations. This paper reviews the surgical treatments, their indications and latest developments.

Congenital glaucoma as an ophthalmic manifestation of Frank–Ter Haar syndrome

We report on a patient with Frank-Ter Haar syndrome that is associated with high intraocular pressures. A 21-day-old male patient was referred to our clinic for surgical treatment of congenital glaucoma. On ophthalmic examination, he had buphthalmos, mild corneal edema and high IOP readings in both eyes. The patient underwent uneventful trabeculotomy surgery, bilaterally. Marked bilateral anterior iris insertion was noted during the surgery. Childhood glaucoma may be associated with Frank-Ter Haar syndrome.

Long Term Outcome of Surgical Management of Congenital Glaucoma

Abstract Objective To look into the long-term outcome of surgical treatment of congenital glaucoma. Methods Children with congenital glaucoma that underwent goniotomy, trabeculotomy, combined trabeculotomy–trabeculectomy, trabeculectomy, cyclocryotherapy, Nd-Yag-cyclophotocoagulation, and Ahmed valve implant from January 1988 to December 1997 were reviewed in December 2007. Results 44 eyes of 25 patients, 16 male and 9 female, reviewed. The mean age at diagnosis was 10.5 (range 0.03–180) months. Twenty three (92%) patients were diagnosed to have congenital glaucoma at or shortly after birth. Thirty seven eyes (84.1%) had primary infantile glaucoma, 3 eyes (6.8%) had developmental glaucoma and 4 eyes (9.1%) had secondary glaucoma. The mean corneal diameter 12.7 (range 9–18) mm, and mean cupping 0.7 (range 0.2–1.0). 78 glaucoma procedures were performed with the mean patient's age at the time of surgery 34.4 (range 0.07 - 181) months. The mean intraocular pressure reduced from 26.7 to 14.0 mmHg in 15 eyes (34%) after a mean number of operation/eye of 1.8, and a mean follow up of 54.3 months. Kaplan-Meier life-table analysis showed decreasing success rates with time of all procedures. However, trabeculectomy was clearly the most successful in our hands. No serious surgical complications. Vision (≥ 6/12) achieved in 27.3% of eyes, and 63.6% of the eyes were legally blind (≤ 6/60). Conclusion Primary trabeculectomy is safe and effective in children with CG operated on by general ophthalmologist. The success rate of all surgical procedures decreased on long term follow up. The visual outcome is satisfactory in about 1/3 of the investigated eyes.

External trabeculotomy in the surgical treatment of congenital glaucoma.

Recent advances in ophthalmic microsurgical instrumentation and techniques make ab-externo trabeculotomy a more attractive alternative to goniotomy in the treatment of congenital glaucoma than was the case in the past. A series of seven consecutive cases (14 eyes) treated by trabeculotomy is presented, with the results of follow-up over a period of two to seven years. This, and other series, suggests that control of developmental glaucoma may be achieved utilizing fewer procedures when trabeculotomy is employed rather than goniotomy.

Surgical Treatment of Congenital Glaucoma : A New Contact Lens for Goniotomy

Surgical Treatment of Congenital Glaucoma : A New Contact Lens for Goniotomy