Long-term results of surgery in childhood glaucoma

Alsheikheh A, Klink J, Klink T, Steffen H, Grehn F.
University Eye Hospital Wuerzburg, Josef-Schneider-Str.11, 97080, Wuerzburg, Germany, f.grehn@augenklinik.uni-wuerzburg.de.

PURPOSE: The aim of this study is to assess the functional results and morphological parameters in children surgically treated for glaucoma. METHODS: Data from 43 patients and 68 eyes who were operated in our department between 1990 and 2002 were collected. This retrospective trial included primary congenital glaucoma (n=36), and secondary glaucoma (n=7) in Rieger-Axenfeld syndrome and Sturge Weber syndrome. Intraocular pressure (IOP), axial length of the eyeball, visual acuity, refractive errors and orthoptic status were analysed. RESULTS: The age of patients at the first surgery was 6.0+/-5.3 months (range 0.7 to 28.0 months). The mean period of follow-up was 57.3+/-36.8 months (6.0-161.0).The mean number of surgical procedures performed on one eye was 2.5+/-2.4 procedures (1-11). The mean IOP before the first surgery was 31.0+/-7.9 mmHg (17.5-52.0), and was 15.0+/-3.9 mmHg (7.0-28.0) at the last visit. 49 eyes (72.1%) did not need any further medical treatment after the last surgical procedure. The IOP was 18 mmHg or lower without medication in 29 eyes (42.6%) after just one surgical procedure (21 trabeculotomy, 8 combined trabeculotomy/trabeculectomy with or without mitomycin-C). At the first examination, the mean axial length of the eyeball was 22.6+/-1.8 mm (the mean normal value at this age is 20.3+/-0.7 mm), and was 24.4+/-2.0 mm at the last visit (the mean normal value at this age is 22.2+/-0.6 mm). The best corrected visual acuity at the last visit was 0.25+/-4.6 lines; the normal range of visual acuity at this age is from 0.4+/-4.0 lines to 0.8+/-3.0 lines. Visual acuity was 0.32 or more in 53.0% of the eyes. Visual acuity was lower than 0.1 in only 15.2% of the eyes. Myopia was present in 57.4% of the eyes with a mean spherical equivalent of -6.1+/-3.9 dioptres. 15 patients (34.9%) developed strabismus. 22 patients (51.2%) were treated with part-time occlusion. Binocular function as assessed with the Lang-1 test was positive in 17 of 30 patients (56.7%). CONCLUSIONS: Although a good long-term IOP-control can often be achieved in childhood glaucoma, the visual acuity remains below the normal range in most cases despite close orthoptic follow-up.