Long-term surgical results and comparison in childhood glaucoma.

Abstract

Purpose: Comparison of visual and anatomical results according to surgery types in patients with primary congenital glaucoma (PCG), secondary childhood glaucoma, and glaucoma following cataract surgery (GFCS).

Methods: The medical records of pediatric glaucoma patients from 2005 to 2023 at the Ondokuz Mayis University Ophthalmology Clinic were retrospectively reviewed. Participants were classified as undergoing trabeculectomy (TRAB), Ahmed glaucoma valve (AGV) implant, combined TRAB and trabeculotomy (CTT); AGV implant after failed TRAB surgeries (TRAB + AGV). Enrolled patients included PCG, secondary childhood glaucoma, and GFCS groups classified according to the Congenital Glaucoma Research Network guidelines. The groups were analyzed for success rate of surgery, visual acuity (VA), corneal diameter, corneal thickness, intraocular pressure (IOP), number of medications, and refractive errors.

Results: Sixty eyes of 38 patients with a mean age of 10.5 ± 6.1 years were included in the study. The final IOP was 16.9 ± 7.4, and the final VA was 0.68 ± 0.66 logMAR. The groups had similar final IOP, cup-to-disc ratio, and complications. The CTT group had the highest overall success rate at 91.7%, whereas the AGV implant group had the lowest at 50%. The final horizontal corneal diameter was 12.6-1.29 mm in the CTT group, 12.62-1.04 mm in the TRAB group (the lowest), and 13.72-0.93 mm in the AGV implant group (the highest) (P = 0.009). The proportion of patients with good VA at the final follow-up was highest in the CTT group at 50%.

Conclusion: Various procedures can achieve effective IOP control in most patients. Childhood glaucoma requires long-term close follow-up for a good visual and anatomical prognosis. Considering the success rate and visual prognosis of CTT in childhood glaucoma, it may be a good choice as first-line surgery.