Treatment Of Childhood Glaucoma Research Articles

Research progress in the diagnosis and treatment of childhood glaucoma

Childhood glaucoma is a disease that seriously endangers children's visual health. It will accompany the patients throughout their lives and bring a heavy burden to families and society. Most childhood blindness caused by glaucoma is preventable or treatable. Relevant research has made progress in recent years. Based on the new consensus reached by the World Glaucoma Association and the latest medical evidence at home and abroad, this article summarizes the definition, classification, diagnosis, molecular genetics, pathogenesis and comprehensive treatments including drugs and surgery of childhood glaucoma, with a focus on the application of various surgical methods, so as to provide reference for clinical and scientific research and improve the clinical diagnosis and treatment of childhood glaucoma.

The Ahmed glaucoma drainage device: long-term clinical outcomes in the pediatric population

The Ahmed glaucoma drainage device (GDD) is commonly employed in the treatment of childhood glaucoma, but large studies with long-term follow-up are lacking.1, 2 Purpose: to characterize long-term performance of this GDD in children with primary and secondary glaucoma.

Применение дренажной системы Ahmed в хирургическом лечении глаукомы детского возраста

Purpose – to evaluate the effectiveness of surgical treatment of glaucoma in children with implantation of the Ahmed Glaucoma Valve drainage system, depending on the form of the disease. Materials and methods. 124 implantations of the Ahmed Glaucoma Valve FP8 drainage system, model FP8, were performed in the Kaluga branch of the IRTC «Eye Microsurgery» for children with various forms of glaucoma for the period of time from 2010 to 2020. The range of children age was from 0 to 18 years old. Primary implantation was performed in 48 cases. 76 implantations were performed after previous glaucoma interventions. 23 patients were operated on in both eyes. The operation was performed with organ-preserving purpose for 26 patients at different ages. Implantation was performed for the eyes with low visual capabilities (below 0.06) in 34 cases. Results. It was noted to decrease in the level of IOP in various types of glaucoma in children in the early postoperative period, in 100% of cases. The level of IOP remained within the normal range in 68% of cases in terms of up to 1 year. The reasons of the increase in the level of ophthalmotonus were associated with the formation of a fibrous capsule above the drainage body and a disturbance in the flow of intraocular fluid in 32% of cases. An increase of IOP was noted up to 3 years in fifty per cent of cases. IOP was regulated by the appointment of antihypertensive medicine in the eyes, where the increase of IOP was not accompanied by significant visual signs of the formation of a fibrous filter pad. Otherwise, the inspection zone of the filtration pad was conducted an audit with excision of the fibrous tissue forming above the drainage body area. As a result, the level of IOP has reached normal values. Conclusion. Along with traditional treatment methods, operations using the Ahmed drainage system are promising in the treatment of childhood glaucoma. In case of some types of congenital glaucoma, they may be the operations of the first choice (in the associated and all secondary types of glaucoma). Undoubtedly, this type of surgery requires further improvements. Including the development of materials to cover the drainage system, which will interfere with severe scarring processes.

360° trabeculotomy for pediatric glaucoma

Congenital glaucoma disease leads to blindness if left untreated. It is estimated that 1 child in 10,000 in Germany is born with congenital glaucoma. In adults the disease develops slowly and insidiously, whereas congenital glaucoma leads to a rapid growth of the eye (buphthalmos) mostly directly after birth due to a very high intraocular pressure. The cause is dysgenesis of the iridocorneal angle. Successful operative treatment of congenital glaucoma is possible in the majority of cases (approximately 80-90%). The treatment of childhood glaucoma is primarily surgical. Since 1960 classical probe trabeculotomy has been the most commonly used procedure, which has the advantage that unlike goniotomy, it can also be performed in cases with clouding of the cornea. In this surgery the canal of Schlemm is probed and the inner wall as well as the trabecular meshwork is opened inwardly over approximately 120°. In recent years the 360° trabeculotomy procedure has become established, in which an illuminated catheter filled with viscoelastic material is used (as with conventional canaloplasty) to dilate the canal of Schlemm. The trabecular meshwork is then inwardly opened by pulling on the ends of the catheter. The results of this method are explained in this article.

Clinical observation of microcatheter assisted trabeculotomy on the treatment of childhood glaucoma

Objective To investigate the clinical efficacy and safety of microcatheter assisted trabeculectomy on the treatment of childhood glaucoma. Methods A prospective case series method was performed.Sixteen childhood glaucoma with 22 eyes were enrolled in Henan Eye Hospital and Zhengzhou Second People's Hospital from December 2016 to August 2017.Nine males with 12 eyes and 7 females with 10 eyes were included, and the age ranged from 6 months to 8 years (median 4 years). All the subjects underwent microcatheter assisted trabeculectomy.The intraocular pressure changes were observed preoperation and 7 days, 1 month and 6 months after surgery, and the postoperative complications were analyzed.This study was approved by the Ethics Committee of Henan Eye Hospital (2018KS-01)and Zhengzhou Secord People's Hospital (No.20161202001), and adhered to the tenets of the Declaration of Helsinki.Written informed consent was obtained from each guardia prior to any medical examination. Results Twenty eyes of 14 patients underwent microcatheter assisted trabeculectomy, the success rate was 90.91%.Twelve eyes were operated with full incision (incision range was 360°), 8 eyes were performed with subtotal incision (incision range was 180°-330°), while the microcatheter could not pass over 90° in 2 eyes and was switch to traditional Harms knife trabeculotomy-trabeculectomy intraoperatively.The intraocular pressures of the 20 eyes that underwent microcatheter assisted trabeculectomy preoperation, 7 days, 1 month and 6 months after surgery were (26.55±4.38), (20.48±3.62), (13.71±6.35) and (12.67±5.37)mmHg, respectively.The intraocular pressures in patients at different time points were statistically significant (F=112.771, P<0.001). At the last follow-up, the intraocular pressures of 18 eyes were controlled.Among them, 16 eyes achieved completely controlled intraocular pressure while 2 eyes returned to normal intraocular pressure after using ocular hypotensive drugs.The intraocular pressure of 2 eyes increased again after operation, and the intraocular pressure could not be controlled after combined use of anti-hypertensive drugs.All patients had no serious complications during and after the operation.Different degrees of anterior chamber hemorrhage occurred in 16 eyes during the surgery, and all the hemorrhages were absorbed within 1 week after surgery. Conclusions For children with glaucoma, microcatheter assisted trabeculectomy can achieve good intraocular pressure reduction effect without serious complications. Key words: Trabeculotomy; Childhood glaucoma; Microcatheter; Intraocular pressure

Trabeculectomy with Mitomycin-C versus trabeculectomy with 5-Fluorouracil for the treatment of childhood glaucoma

Background: Childhood Glaucoma (CG) is common in Saudi Arabia and challenging. Purpose: To compare efficacy and safety of trabeculectomy with Mitomycin-c (TMMC) and trabeculectomy with 5-Fluorouracil (T5FU) in children with CG. Materials and Methods: The charts of 35 children with CG who underwent T5FU or TMMC between January 1994 and December 2004, were retrospective reviewed. The efficacy and safety of the two procedures were compared. Results: 33 eyes of 20 children underwent T5FU and 24 eyes of 15 children underwent TMMC. There was no significant difference between the groups preoperatively, except for mean pre-operative age at the time of operation and medications. 25 (75.8%) eyes in T5FU and 18(75%) eyes in TMMC group were considered successful at mean follow up of 58.6 and 42.2 months respectively. 14 (56%) eyes in T5FU and 12 (66.7%) eyes in TMMC were on no antiglaucoma medications. 10 eyes in T5FU and 6 eyes in TMMC had previous failed procedures. No significant difference between the groups was present on last follow up, with respect to success rate ( P =1.00), follow up ( P =0.4012), medications ( P =0.3467), complications ( P =0.303)] and visual outcome ( P =0.593). Serious complications including, hypotony, retinal detachment, and flat anterior chamber occurred after T5FU and one eye in TMMC group developed bleb-related endophthalmitis. Intraoperative (topical and injection) use of 5FU was as effective as MMC. Conclusions: 5-Fluorouracil and Mitomycin-C are equally effective as adjuncts to trabeculectomy in CG. Their use can be associated with serious complications. Further study is needed to evaluate intraoperative 5-Fluorouracil augmented trabeculectomy in CG.

Management of refractory glaucoma in childhood.

Glaucoma in children is characterized by marked intraocular pressure (IOP) elevation with resultant atrophy of the optic nerve and loss of retinal ganglion cells. In very young children, secondary expansion of the globe with damage to anterior segment structures, such as the cornea and zonule, often occurs. Permanent, severe visual dysfunction may result from optic nerve damage as well as from amblyopia arising from anisometropia and corneal opacification. The treatment of childhood glaucoma often involves surgery. Goniotomy and trabeculotomy remain the first line surgical procedures for open-angle glaucoma in children. Trabeculectomy with adjunctive antifibrosis therapy, aqueous shunt surgery, and cyclodestructive procedures are undertaken when angle surgery fails to control the IOP or is unlikely to succeed. The choice of surgical procedure is individualized according to factors such as the age of the patient, the specific type of glaucoma, the number of prior surgical procedures, and the visual potential of the eye. Achieving and maintaining an adequate IOP to prevent progressive optic nerve damage, avoiding complications, and preserving vision are the goals that must be considered in deciding on a surgical plan.

Timolol in childhood glaucoma

In determining the role of timolol in the treatment of childhood glaucoma, the difficulties of conducting investigational studies in children and the possible delayed appearance of longterm side effects are real concerns. However, an equally important consideration is the fact that young children may face a lifetime of blindness from uncontrolled glaucoma. Timolol is not always successful in lowering intraocular pressure on a longterm basis in severe glaucoma, but it often does help in managing extremely difficult cases. In some respects, the results of using timolol in children are consistent with those achieved with severe adult glaucoma. Although experience with children under one year of age is still extremely limited, theoretical considerations would suggest that children might be particularly vulnerable to the known systemic side effects following local absorption, as well as to longterm side effects that are yet unknown.