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Deep sclerectomy combined with trabeculectomy in pediatric glaucoma.

Abstract：

PURPOSE:To evaluate the outcomes of combined deep sclerectomy and trabeculectomy (penetrating deep sclerectomy) in pediatric glaucoma. DESIGN:Retrospective, nonconsecutive, noncomparative, interventional case series. PARTICIPANTS:Children suffering from pediatric glaucoma who underwent surgery between March 1997 and October 2006 were included in this study. METHODS:A primary combined deep sclerectomy and trabeculectomy was performed in 35 eyes of 28 patients. Complete examinations were performed before surgery, postoperatively at 1 and 7 days, at 1, 2, 3, 4, 6, 9, and 12 months, and then every 6 months after surgery. MAIN OUTCOME MEASURES:Surgical outcome was assessed in terms of intraocular pressure (IOP) change, additional glaucoma medication, complication rate, need for surgical revision, as well as refractive errors, best-corrected visual acuity (BCVA), and corneal clarity and diameters. RESULTS:The mean age before surgery was 3.6+/-4.5 years, and the mean follow-up was 3.5+/-2.9 years. The mean preoperative IOP was 31.9+/-11.5 mmHg. At the end of follow-up, the mean IOP decreased by 58.3% (P<0.005), and from 14 patients with available BCVA 8 patients (57.1%) achieved 0.5 (20/40) or better, 3 (21.4%) 0.2 (20/100), and 2 (14.3%) 0.1 (20/200) in their better eye. The mean refractive error (spherical equivalent [SE]) at final follow-up visits was +0.83+/-5.4. Six patients (43%) were affected by myopia. The complete and qualified success rates, based on a cumulative survival curve, after 9 years were 52.3% and 70.6%, respectively (P<0.05). Sight-threatening complications were more common (8.6%) in refractory glaucomas. CONCLUSIONS:Combined deep sclerectomy and trabeculectomy is an operative technique developed to control IOP in congenital, secondary, and juvenile glaucomas. The intermediate results are satisfactory and promising. Previous classic glaucoma surgeries performed before this new technique had less favorable results. The number of sight-threatening complications is related to the severity of glaucoma and number of previous surgeries. FINANCIAL DISCLOSURE(S):The authors have no proprietary or commercial interest in any materials discussed in this article.

journal_name

Ophthalmology

journal_title

Ophthalmology

authors

Feusier M,Roy S,Mermoud A

doi

10.1016/j.ophtha.2008.08.039

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

30-8

issue

eissn

0161-6420

issn

1549-4713

pii

S0161-6420(08)00833-6

journal_volume

116

pub_type

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Deep sclerectomy combined with trabeculectomy in pediatric glaucoma.