Surgical outcomes with 360-degree suture trabeculotomy in poor prognosis primary congenital glaucoma and glaucoma associated with congenital anomalies or cataract surgery

• Type of Material: Article
• Authors: Allen D Beck, Emory University; Michael Lynn, Emory University; James Crandall, The Glaucoma Institute; Omar Mobin-Uddin, The Glaucoma Institute
• Language: English
• Date: 2011-02
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2010 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jaapos.2010.12.002
• Title of Journal or Parent Work: Journal of American Association for Pediatric Ophthalmology and Strabismus
• ISSN: 1091-8531
• Volume: 15
• Issue: 1
• Start Page: 54
• End Page: 58
• Grant/Funding Information: This study was supported in part by an unrestricted grant from Research to Prevent Blindness Inc., New York, New York, and by P30 EYO6360 (National Institutes of Health Departmental Core Grant, Bethesda, Maryland).
• Research Categories: Health Sciences, Opthamology; Health Sciences, Human Development

Abstract

Purpose: To evaluate the outcomes of 360-degree suture trabeculotomy in childhood glaucoma with poor prognosis. Subjects and Methods: A nonrandomized, retrospective chart review was performed on pediatric patients (under 18 years old) treated with a 360-degree suture trabeculotomy for glaucoma. The cases were categorized into the following groups: (1) primary congenital glaucoma with birth-onset presentation accompanied by corneal clouding noted at birth, (2) primary congenital glaucoma with onset or presentation after 1 year of age, (3) primary congenital glaucoma with prior failed goniotomy surgery, (4) infantile-onset glaucoma following congenital cataract surgery, and (5) infantile-onset glaucoma with associated ocular/systemic anomalies. Results: A total of 45 eyes of 33 patients were analyzed. The mean preoperative intraocular pressure (IOP) was 34.3 ± 6.7 mm Hg on an average of 1.5 medications. Median age at time of surgery was 7 months. Mean final IOP (median last follow-up or failure, 12 months) was 22.2 ± 7.1 mm Hg on an average of 1.5 medications. The probability of success according to time after surgery was 87% at 6 months, 63% at 1 year, and 58% at 2 years. Kaplan-Meier analysis of Groups 1-4 versus Group 5 failed to demonstrate a statistically significant difference (p = 0.13). Of 5 eyes with port wine mark–related glaucoma, 2 had a large (>50%), persistent postoperative hyphema and concurrent vitreous hemorrhage. Conclusions: Children with a wide range of ocular pathologies can be successfully treated with 360-degree suture trabeculotomy. Further evaluation of this surgical technique in primary congenital glaucoma and open-angle glaucoma following congenital cataract surgery is warranted.