1
|
Incandela C, Ferreri P, Sisto D, Alessio G. Argon laser trabeculoplasty for congenital ectropion uveae: Case report and review of the literature. Eur J Ophthalmol 2023; 33:NP35-NP40. [PMID: 36751028 DOI: 10.1177/11206721231156501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A 18-year-old woman with unilateral glaucoma secondary to congenital ectropion uveae (CEU) in the right eye, without other systemic and ocular associations. Intraocular pressure (IOP) was uncontrolled under topical therapy. The visual field (VF) was within normal limits; retinal nerve fiber layer (RNFL) thickness, as evaluated by Optical Coherence Tomography (OCT), was reduced. The patient refused surgical intervention. After evaluation of the iridocorneal angle, ALT was performed as follows: 95 spots were applied for the 270 ° of visible trabecular meshwork using a laser beam diameter of 50 μm, an exposure time of 0.1 s and a power of 750 mw). Mean IOP in the right eye, as evaluated by diurnal tonometric curve, was 10 mmHg, 16 mmHg and 20 mmHg respectively one month, four months and eight months after ALT, with no additional topical therapy, and 18 mmHg twelve months after ALT with topical therapy. CEU is a rare, non-progressive anomaly characterized by the proliferation of iris pigment epithelium on anterior surface of iris; glaucoma, in this disorder, is often poorly controlled with medical therapy alone. In a phase of initial glaucomatous damage and with a not particularly high IOP, as in this case, ALT could be an alternative therapeutic option at least in the short-term, when surgery is not feasible immediately. In fact, given its limited effectiveness over time, ALT can be used as a temporary control measure of IOP, pending surgery to become feasible.
Collapse
Affiliation(s)
- Cosimo Incandela
- Department of Neurosciences, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Paolo Ferreri
- Department of Neurosciences, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Dario Sisto
- Department of Neurosciences, Institute of Ophthalmology, University of Bari, Bari, Italy
| | - Giovanni Alessio
- Department of Neurosciences, Institute of Ophthalmology, University of Bari, Bari, Italy
| |
Collapse
|
2
|
Mandal AK, Gothwal VK. Glaucoma management in congenital ectropion uveae: Surgical outcomes from a large tertiary referral center in South India. Eur J Ophthalmol 2023; 33:324-332. [PMID: 35769044 DOI: 10.1177/11206721221111595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the long-term outcomes of glaucoma management in patients with congenital ectropion uveae (CEU) over a period of three decades at a single large referral tertiary eye care center. METHODS Retrospective chart review of all patients with CEU treated surgically from 1990 to 2019 was performed. Primary combined trabeculotomy-trabeculectomy (CTT), trabeculectomy with and without mitomycin-C (MMC) (0.2 mg/mL for 1 min) and transscleral cyclophotocoagulation (TSCPC) were performed. Intraocular pressure (IOP) ≥6 and ≤16 mmHg without medications was considered as complete success and IOP≤ 16 mmHg with the use of upto 2 medications as qualified success. RESULTS A total of 26 eyes of 21 patients were identified with a median age of 7 years (range, 6 days to 19 years) at the time of glaucoma surgery. Median follow-up was 51.1 months (range, 7-244.6 months). Primary CTT was performed in 17 eyes (65%), trabeculectomy in 5 eyes (19%) with application of MMC in 2 eyes, and 3 eyes (12%) underwent TSCPC. One painful blind eye (4%) underwent evisceration. Mean IOP reduced from 30.8 ± 7.6 mmHg on a mean of 1.3 ± 0.8 glaucoma medications preoperatively to a mean IOP of 15.2 ± 5.9 mmHg (P < 0.0001) on a mean of 0.2 ± 0.5 medications postoperatively at final follow-up (P = 0.0009). Complete success was achieved in 20 eyes, and qualified success in 2 eyes. CONCLUSIONS CTT is a safe and efficacious primary procedure for management of early-onset glaucoma in CEU. Trabeculectomy with or without adjuvant MMC is a viable second line of treatment in late-onset glaucoma with CEU for IOP control.
Collapse
Affiliation(s)
- Anil K Mandal
- Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, Hyderabad, Telangana, India.,VST Centre for Glaucoma Care, Hyderabad, Telangana, India
| | - Vijaya K Gothwal
- Meera and L B Deshpande Centre for Sight Enhancement, Institute for Vision Rehabilitation, Hyderabad, Telangana, India.,Brien Holden Centre for Eye Research - Patient Reported Outcomes Unit, 28592L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
3
|
Thananjeyan AL, Karaconji T, Flaherty M, Zagora S, Jamieson RV, Grigg JRB. A case of neurofibromatosis type 1 and unilateral glaucoma with ectropion uveae. Ophthalmic Genet 2022; 43:709-712. [PMID: 35722677 DOI: 10.1080/13816810.2022.2089362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Akshaya L Thananjeyan
- University of Sydney School of Rural Health, Dubbo Base Hospital, Dubbo, NSW, Australia
| | - Tanya Karaconji
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia.,Department of Ophthalmology, The Children's Hospital Westmead, Sydney, NSW, Australia
| | - Maree Flaherty
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia.,Department of Ophthalmology, The Children's Hospital Westmead, Sydney, NSW, Australia
| | - Sophia Zagora
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia.,Department of Ophthalmology, The Children's Hospital Westmead, Sydney, NSW, Australia
| | - Robyn V Jamieson
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia.,Eye Genetics Research Group Children's Medical Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Disciplines of Genetic Medicine, and Child and Adolescent, Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - John R B Grigg
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia.,Eye Genetics Research Group Children's Medical Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Disciplines of Genetic Medicine, and Child and Adolescent, Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
4
|
Chen M, Li Y, Cheng B, Zhang Q, Liu X, Wang K. CO 2 Laser-Assisted Sclerectomy vs. Microcatheter-Assisted Trabeculotomy in the Management of a Bilateral Congenital Ectropion Uveae With Glaucoma: A Case Report and Literature Review. Front Med (Lausanne) 2022; 9:902716. [PMID: 35665343 PMCID: PMC9160387 DOI: 10.3389/fmed.2022.902716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Bilateral congenital ectropion uveae (CEU) is rare syndrome, usually accompanied by refractory glaucoma. Proper and timely treatment was very important for the prognosis. The report aims to compare the long-term outcomes and complications between the two eyes after different approaches of surgery in a case of bilateral CEU with advanced glaucoma. Case Presentation The patient was a 20-year-old male with bilateral CEU and glaucoma. The intraocular pressure (IOP) was 48 mm Hg in the right eye (OD) and 52 mm Hg in the left eye (OS). The vertical cup-to-disc (C/D) ratio was nearly 1.0 in both eyes. Despite maximum medical therapy, the target IOP could not be achieved. Therefore, CO2 laser-assisted sclerectomy surgery (CLASS) was performed in OS, and the IOP was remarkably decreased. 1 month after the surgery, the IOP rebounded slightly and was controlled with a fixed-combination anti-glaucoma medicine. 3-month postoperatively, a YAG laser goniopuncture (LGP) was performed to enhance the IOP-lowing effect and the anti-glaucoma agent was discontinued. An ab externo microcatheter-assisted trabeculotomy (MAT) was performed in OD, and the IOP was also significantly decreased. During the follow-up period, the IOP was well controlled for both eyes without any medication. Shallow anterior chamber and complicated cataract developed in OS after CLASS, and there was no obvious late complication in OD after MAT. Conclusions To our knowledge, this was the first attempt to perform two different surgeries, CLASS and MAT, in both eyes of a single patient presented with bilateral CEU with glaucoma. Our results showed that the IOP was lower after CLASS, but there were potential complications such as shallow anterior chamber and complicated cataract. MAT could achieve a moderate IOP-lowing effect but had a higher safety. CLASS and MAT may be considered effective surgical options for the management of such patients.
Collapse
Affiliation(s)
- Min Chen
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yuhang Li
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Bo Cheng
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Department of Ophthalmology, Fenghua People's Hospital, Zhejiang, China
| | - Qi Zhang
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Xin Liu
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Kaijun Wang
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| |
Collapse
|
5
|
Jacobson A, Moroi SE, Bohnsack BL. Characteristics and Outcomes of Glaucoma Associated With Congenital Ectropion Uvea. Am J Ophthalmol 2022; 241:1-8. [PMID: 35358486 DOI: 10.1016/j.ajo.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To determine the visual outcomes and effectiveness of glaucoma surgeries in congenital ectropion uvea. DESIGN Retrospective interventional case series. METHODS Surgeries and examination findings were collected on 11 eyes of 8 patients with congenital ectropion uvea at 2 academic sites from 2001 to 2021. Visual outcomes, surgical success (intraocular pressure [IOP]: 5-20 mm Hg, no additional IOP-lowering surgery, no visually devastating complications), and survival rates of glaucoma surgeries were assessed. RESULTS Glaucoma in bilateral congenital ectropion uvea was diagnosed at an earlier age (0.02 ± 0.01 years) than unilateral disease (8.9 ± 5.3 years, P = .002). All eyes required glaucoma surgery with 91% requiring multiple surgeries (3.5 ± 2.1, median 3 surgeries per eye). Trabeculotomy (8 eyes) showed 13% success rate. Although none of the 4 eyes that underwent trabeculectomy with mitomycin C needed repeat trabeculectomy, glaucoma drainage device placement, or cycloablation, 75% required bleb revision surgery. Glaucoma drainage devices (7 eyes) had a 57% success rate with 3 eyes requiring subsequent cycloablation (2) or trabeculectomy (1). At the final follow-up (8.5 ± 6.6 years, median: 7.9 years), all eyes achieved IOP control, and IOP was lower compared with presentation (13.2 ± 2.6 mm Hg vs 32.9 ± 9.9 mm Hg, P = .002). Best-corrected logarithm of the minimum angle of resolution visual acuity at the final follow-up was 0.2 ± 0.2. CONCLUSIONS Bilateral congenital ectropion uvea presents with glaucoma earlier than unilateral cases. The majority of eyes required multiple glaucoma surgeries. Angle surgery was less effective than trabeculectomy or glaucoma drainage devices. IOP control was obtained in all eyes and affected individuals had good visual outcomes.
Collapse
|
6
|
Rezaei L, Ahmadyani R. A Very Rare Association of Fuchs Heterochromic Uveitis and Ectropion Uvea in Usher Syndrome. Adv Biomed Res 2022; 10:50. [PMID: 35127577 PMCID: PMC8781905 DOI: 10.4103/abr.abr_286_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022] Open
Abstract
Usher syndrome is a heterogeneous genetic disease that is the most common cause of hereditary blindness–deafness. This syndrome is the most prevalent syndrome associated with retinitis pigmentosa. A 25-year-old man referred to us with hearing loss and vision diminution since childhood which has gradually worsened. Visual acuity of both eyes was 20/100. Slit lamp examination of the left eye revealed endothelial stellate keratic precipitates, mild anterior chamber reaction, iris heterochromia, ectropion of uvea, and mild posterior subcapsular cataract. There were also no crypts and abnormal vessels in the left eye iris. His intraocular pressure was 14 mmHg in the right eye and 18 mmHg in the left one. Funduscopy demonstrated waxy pallor optic nerve, marked arterial narrowing, and retinal bone spicule pigment formation in both eyes. We report for the first time a very rare association between Usher syndrome, Fuchs heterochromic uveitis (FHU), and ectropion uvea. To our knowledge, no association has been reported between ectropion uvea, FHU, and Usher syndrome.
Collapse
Affiliation(s)
- Leila Rezaei
- Associate Professor of Ophthalmology, Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rashed Ahmadyani
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
7
|
Long-term treatment outcomes for congenital ectropion uveae with ptosis and glaucoma. J AAPOS 2020; 24:369-371. [PMID: 33573764 DOI: 10.1016/j.jaapos.2020.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 11/23/2022]
Abstract
We describe 3 cases of unilateral congenital ectropion uveae associated with ptosis and glaucoma in a syndrome with no systemic associations. Early detection of glaucoma and timely surgical intervention is required to preserve productive vision in such patients. In our case series, trabeculectomy with mitomycin C was effective in controlling glaucoma progression over a follow-up period of 5-15 years.
Collapse
|
8
|
Chan JCH, Chow SC, Lai JSM. Retrospective analysis of paediatric glaucoma at a tertiary referral centre in Hong Kong. Jpn J Ophthalmol 2020; 65:115-121. [PMID: 33104957 DOI: 10.1007/s10384-020-00779-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the epidemiological features, clinical interventions, and outcomes of paediatric glaucoma in Hong Kong. STUDY DESIGN Retrospective chart review. METHODS Clinical data from the medical records of all patients under 18 years of age diagnosed with glaucoma from January 2008 to December 2017 at a university-affiliated, tertiary referral centre were collected. The patients' demographics, etiological distribution, clinical interventions, and outcomes were analysed. RESULTS A total of 33 subjects (53 eyes) were identified, 30 (49 eyes) of whom were Chinese. Primary glaucoma accounted for 21.2% of subjects, while 78.8% were diagnosed with secondary glaucoma. The most common subtype was juvenile-onset open angle glaucoma, followed by Sturge-Weber Syndrome related glaucoma. The most commonly performed surgical interventions were tube-shunt surgery (Ahmed Glaucoma Valve) and transscleral cyclophotocoagulation. Most eyes had significant reduction in intraocular pressure after medical or surgical intervention, but deterioration of visual acuity remained common. CONCLUSION Most cases of childhood glaucoma in Hong Kong are secondary rather than primary, similar to other regions with low incidence of parental consanguinity. The large proportion of secondary glaucoma which generally has poorer prognosis, is reflected by the frequency of multiple surgery, and a high incidence of visual deterioration despite significant intraocular pressure reduction in most eyes.
Collapse
Affiliation(s)
- Jonathan Cheuk-Hung Chan
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, People's Republic of China.
| | - Shing Chuen Chow
- LKS Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - Jimmy Shiu-Ming Lai
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, People's Republic of China
| |
Collapse
|
9
|
Zepeda EM, Branham K, Moroi SE, Bohnsack BL. Surgical outcomes of Glaucoma associated with Axenfeld-Rieger syndrome. BMC Ophthalmol 2020; 20:172. [PMID: 32357855 PMCID: PMC7193416 DOI: 10.1186/s12886-020-01417-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 03/31/2020] [Indexed: 12/12/2022] Open
Abstract
Background The surgical management of glaucoma associated with Axenfeld-Rieger Syndrome (ARS) is poorly described in the literature. The goal of this study is to compare the effectiveness of various glaucoma surgeries on intraocular pressure (IOP) management in ARS. Methods Retrospective cohort study at a university hospital-based practice of patients diagnosed with ARS between 1973 and 2018. Exclusion criterion was follow-up less than 1 year. The number of eyes with glaucoma (IOP ≥ 21 mmHg with corneal edema, Haabs striae, optic nerve cupping or buphthalmos) requiring surgery was determined. The success and survival rates of goniotomy, trabeculotomy±trabeculectomy (no antifibrotics), cycloablation, trabeculectomy with anti-fibrotics, and glaucoma drainage device placement were assessed. Success was defined as IOP of 5-20 mmHg and no additional IOP-lowering surgery or visually devastating complications. Kaplan-Meier survival curves and the Wilcoxon test were used for statistical analysis. Results In 32 patients identified with ARS (median age at presentation 6.9 years, 0–58.7 years; median follow-up 5.4 years, 1.1–43.7 years), 23 (71.9%) patients were diagnosed with glaucoma at median age 6.3 years (0–57.9 years). In glaucomatous eyes (46 eyes), mean IOP at presentation was 21.8 ± 9.3 mmHg (median 20 mmHg, 4-45 mmHg) on 1.0 ± 1.6 glaucoma medications. Thirty-one eyes of 18 patients required glaucoma surgery with 2.2 ± 1.2 IOP-lowering surgeries per eye. Goniotomy (6 eyes) showed 43% success with 4.3 ± 3.9 years of IOP control. Trabeculotomy±trabeculectomy (6 eyes) had 17% success rate with 14.8 ± 12.7 years of IOP control. Trabeculectomy with anti-fibrotics (14 eyes) showed 57% success with 16.5 ± 13.5 years of IOP control. Ahmed© (FP7 or FP8) valve placement (8 eyes) had 25% success rate with 1.7 ± 1.9 years of IOP control. Baerveldt© (250 or 350) device placement (8 eyes) showed 70% success with 1.9 ± 2.3 years of IOP control. Cycloablation (4 eyes) had 33% success rate with 2.7 ± 3.5 years of IOP control. At final follow-up, mean IOP (12.6 ± 3.8 mmHg, median 11.8 mmHg, 7-19 mmHg) in glaucomatous eyes was significantly decreased (p < 0.0001), but there was no difference in number of glaucoma medications (1.6 ± 1.5, p = 0.1). Conclusions In our series, greater than 70% of patients with ARS have secondary glaucoma that often requires multiple surgeries. Trabeculectomy with anti-fibrotics and Baerveldt glaucoma drainage devices showed the greatest success in obtaining IOP control.
Collapse
Affiliation(s)
- Emily M Zepeda
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Kari Branham
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Sayoko E Moroi
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Brenda L Bohnsack
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA.
| |
Collapse
|
10
|
Rate of Complete Catheterization of Schlemm's Canal and Trabeculotomy Success in Primary and Secondary Childhood Glaucomas. Am J Ophthalmol 2020; 212:69-78. [PMID: 31836332 DOI: 10.1016/j.ajo.2019.11.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Despite the increasing use of microcatheters to perform 360-degree trabeculotomy, the rate of complete Schlemm's canalization in different forms of pediatric glaucoma is under-reported. DESIGN Retrospective institutional observational case series. METHODS Ocular diagnoses and surgical details of 60 pediatric patients (≤18 years old) who underwent trabeculotomy between 2013 and 2019 were collected. Surgical success was defined as an intraocular pressure (IOP) of 5-20 mm Hg and no additional IOP-lowering surgery. RESULTS Eighty-five eyes of 60 patients underwent trabeculotomy. For bilateral cases, the first eye to undergo surgery was included for analysis. Diagnoses included primary congenital glaucoma (PCG n = 22), juvenile open angle glaucoma (JOAG n = 16), glaucoma following cataract surgery (GFCS n = 15), and other secondary forms of glaucoma (n = 7). Canalization using a microcatheter was attempted in 52 of 60 eyes (87%) of which 21 (40%) achieved full 360-degree. Complete canalization was attained in 69% of JOAG patients, which was significantly higher than in PCG patients (22%; P = 0.007), but not GFCS (36%) and other secondary glaucoma (29%). The 5-year survival rate for all eyes was 75% with 95% confidence interval (CI), 57 to 86. Survival curves for 360-degree catheter, 270-degree to 360-degree combined catheter/Harms trabeculotome, and <180-degree Harms trabeculotome trabeculotomies were significantly different (P < 0.001) with 5-year survival rates of 100%, 69% with 95% CI, 16 to 93, and 48% with 95% CI, 29 to 64, respectively. CONCLUSIONS A 360-degree catheter trabeculotomy is highly effective in obtaining IOP control; however, complete canalization of Schlemm's canal is most frequently achieved in JOAG patients. Congenital anomalies or scarring from previous surgeries, which prevents full canalization, may inherently decrease success of angle surgery in other glaucoma.
Collapse
|
11
|
Glaucoma and Cornea Surgery Outcomes in Peters Anomaly. Am J Ophthalmol 2019; 208:367-375. [PMID: 31470000 DOI: 10.1016/j.ajo.2019.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE To conduct a qualitative description of corneal and glaucoma outcomes in Peters anomaly. DESIGN Retrospective case series. METHODS Children with Peters anomaly who presented between 1982-2017 were included. Visual acuity, intraocular pressure (IOP), survival of corneal grafts, and success of glaucoma surgery (defined as IOP of 5-20 mm Hg and no additional IOP-lowering surgery or visually devastating complications) were analyzed. RESULTS Fifty-eight eyes of 37 patients (19 males) with Peters anomaly presented at 0.7 ± 1.5 years of age and had a follow-up of 10.2 ± 10.8 years. Twenty-three eyes underwent penetrating keratoplasty (PKP) with an average of 2.0 ± 1.3 grafts per eye. PKP survival at 1 year was 60% (95% confidence interval 41-75%) but decreased at 10 years to 34% (95% confidence interval 18-51%). Thirty-four eyes were diagnosed with glaucoma at 2.8 ± 6.4 years of age. Twenty eyes required glaucoma surgery, and the average number of IOP-lowering surgeries was 2.9 ± 2.0 per eye. Glaucoma drainage devices (15 eyes) had a 53% success rate. Laser cycloablation (9 eyes, transcleral or endoscopic) had a success rate of 67% with 2.0 ± 1.0 treatments per eye. Trabeculectomy with mitomycin C (8 eyes) and trabeculotomy (8 eyes) had 25% and 0% success rates, respectively. Fifteen eyes that underwent glaucoma surgery obtained IOP control, and GDD with or without cycloablation accounted for 80% of the successes. Eyes that underwent PKP did not show increased rates of glaucoma, higher IOP, or a greater necessity for IOP-lowering surgery. CONCLUSIONS In Peters anomaly, PKP shows poor long-term success. In addition, >50% of eyes with Peters anomaly have secondary glaucoma that often requires multiple surgeries.
Collapse
|