Childhood glaucoma profile in Dakahelia, Egypt: a retrospective study

AIM： To analyze childhood glaucoma regarding its demographics, presentations, different causes and surgical modalities used among patients in Dakahelia and to apply the Childhood Glaucoma Research Network（CGRN） classification retrospectively to evaluate its convenience.METHODS： A retrospective study in which the medical files of all glaucoma patients 〈16 years old presented to Mansoura Ophthalmic Center, Mansoura University from 2014 to 2017, were retrieved and analyzed. Collected data included： age, gender, laterality, visual acuity（VA）, refraction, intraocular pressure（IOP）, corneal diameter, cup-disc ratio, types and number of surgeries and antiglaucomatous drugs（AGD） at the first and last visit. Prevalence of different subtypes was calculated and means of clinical features were compared.RESULTS： A total of 305 eyes of 207 patients were included classified into 6 groups： primary congenital glaucoma（PCG）, juvenile open angle glaucoma（JOAG）, glaucoma associated with systemic disease, glaucoma associated with ocular anomalies, acquired glaucoma and glaucoma following cataract surgery. PCG was the predominant type（55.1%） followed by acquired glaucoma（29.5%）. Males represented 63.8% of the whole studied patients. Glaucoma associated with ocular anomaly group showed the youngest age at diagnosis（21.9±30.0 mo）. The shortest corneal diameter was recorded in post cataract group（10.4±0.5 mm）. Highest cup-disc ratio was found in the PCG group（P〈0.0005）. Glaucoma associated with systemic disease presented with the highest baseline IOP（34.5±5.0 mm Hg）. All the cases with PCG were treated surgically with 21.8% required more than one surgery. The majority of the patients（74.2%） in the acquired group were treated medically. Combined trabeculotomy-trabeculectomy was the most frequent operation done, accounting for 34.5% of all primary surgeries. Ahmed valve implantation comprised 87% of the secondary surgeries. Acquired glaucoma group had the highest percent of eyes with good final Snellen＇s VA（69.4%）, while glaucoma associated with ocular anomaly group had poorest final VA. CONCLUSION： PCG is the most prevalent type of childhood glaucoma, followed by acquired glaucoma especially traumatic hyphema. Combined trabeculotomytrabeculectomy and Ahmed valve implantation are the most common surgical interventions. CGRN classification is found to provide a consensus skeleton and is recommended to be integrated in our routine ongoing clinical practice.

Launching a paradigm for first and redo-surgery in primary congenital glaucoma: institutional experience

AIM: To evaluate the outcome of the initial and the redo-surgeries for primary congenital glaucoma(PCG) correlated to its degree of severity. METHODS: A retrospective study involved patients with PCG presented between 2010 and 2018. Medical records were reviewed to assess the degree of the preoperative severity according to the intraocular pressure(IOP), corneal diameter and corneal edema. Success and failure rates were calculated for both first and redo-surgeries at 6 and 12 mo respectively then correlated to the severity of the cases. RESULTS: Complete records were retrieved for 272 eyes(153 patients) with PCG: 43 eyes were mild, 136 moderate and 93 severe. Combined trabeculotomy and trabeculectomy(CTT) had the highest success rate in moderate(96.4%) and severe cases(59.3%) while trabeculotomy had the highest success rate in mild cases(96.3%). Medical records of 88 eyes(63 patients) with recurrent PCG were analyzed, most with severe presentation(59 eyes). Ahmed glaucoma valve(AGV) was used in 67(76%) eyes and augmented trabeculectomy in 21(24%) eyes. At 12 mo, there was no statistically significant difference between both surgeries in total success rate(P=0.256). For mild cases, success rate was 100% for both surgeries. Severe cases had higher success rates following AGV(87%) than augmented trabeculectomy(20%). Preoperative severity of the disease was an independent factor affecting the failure rate in secondary trabeculectomy but not in AGV. Patients younger than 24 mo had higher probabilities of failure following both redo-surgeries with hazard ratio =1.325 and 0.37 for augmented trabeculectomy and AGV respectively. CONCLUSION: Preoperative assessment of the severity of eyes with PCG helps in the selecting the optimal primary and secondary surgery. For first surgery, trabeculotomy is more effective in mild cases whereas; CTT and augmented subscleral trabeculectomy(SST) are appropriate for moderate and severe cases. AGV proved to be superior to augmented SST in severe recurrent cases.

Changes of anterior segment parameters after horizontal rectus muscles recession versus resection

Background:To record the corneal,and anterior chamber depth changes after performing recession versus resection of horizontal recti muscles.Methods:Consecutive patients who underwent isolated lateral rectus muscle recession or resection February 2014 to January 2015 were prospectively studied.Refractive error(spherical equivalent);K1,K2,and mean k reading,anterior and posterior corneal elevation;and anterior chamber depth were measured(Pentacam)before,1 month,and 3 months after surgery.Patients who could not maintain reliable fixation and those with a history of eye surgery were excluded.Pre-and postoperative measurements were compared by analysis of variance.Results:A total of 36 eyes of 23 patients(average age,16 years)were included.Rectus muscle recession was performed in 24 eyes;and resection was performed in 12 eyes.Statistically significant changes in mean keratometry of recession group only.Central anterior elevation,and central anterior chamber depth were significant when both groups are compared at first month after surgery.Changes became regressive at the end of the third month.Although a significant change of central anterior elevation persisted.Conclusions:In recession group,the mean K was the only statistically significant variable by the first postoperative month.Comparing the both groups,the anterior corneal elevation,and central anterior chamber depth revealed a significant difference by the end of the first postoperative month.After 3 months,all parameters showed a statistical insignificant difference between the recession and resection groups except the anterior corneal elevation.