Risk profile of deep sclerectomy for treatment of refractory congenital glaucomas.
OBJECTIVE
To evaluate the effectiveness and risk profile of deep sclerectomy in surgery for refractory congenital glaucoma.


METHODS
Retrospective non-comparative interventional case series.


METHODS
Ten eyes of eight consecutive patients underwent deep sclerectomy for refractory congenital glaucoma. The procedure was converted to a trabeculectomy in four eyes and supplemented by a trabeculotomy in two eyes. Six eyes had primary congenital glaucoma, and four eyes had secondary congenital glaucoma. The patients' ages at the time of surgery in our department ranged from 8 months to 14 years. All eyes had a history of previous glaucoma surgery.


METHODS
The surgical outcome was assessed in terms of complication rate, intraocular pressure (IOP) change, need for surgical revision, or additional glaucoma medication.


RESULTS
Preoperatively, the mean IOP was 31.9 mmHg (standard deviation [SD], 5.6 mmHg). At first follow-up 1 week after surgery, the mean IOP for all eyes was 12.7 mmHg (SD, 6.8 mmHg). The average reduction of IOP was statistically significant (P < 0.001). In accordance with the success criteria, all eyes were ultimately classified as failures. Average time to failure was 2.1 months (SD, 3.6 months). Specific complications were seen in terms of non-identification of Schlemm's canal (40%), choroidal deroofing (10%), and visible perforation of the trabeculodescemetic membrane (20%). Further complications were hyphema (40%), ocular hypotony (10%), vitreous hemorrhage (10%), and vitreous loss with subsequent retinal detachment (10%).


CONCLUSIONS
Although deep sclerectomy may reduce the IOP in patients with refractory congenital glaucoma, this study indicates a specific risk profile associated with deep sclerectomy in surgery for refractory congenital glaucoma.
Lüke
Christoph
C
Zentrum für Augenheilkunde, Universität Köln, Köln, Germany.
Dietlein
Thomas S
TS
Jacobi
Philipp C
PC
Konen
Walter
W
Krieglstein
Günter K
GK
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005901:Glaucoma / Q000151:congenital* / Q000601:surgery*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007223:Infant; D007267:Injections; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D008297:Male; D008970:Molecular Weight; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012599:Sclerostomy / Q000379:methods*; D014130:Trabeculectomy; D017211:Treatment Failure
D006820:Hyaluronic Acid