Deep sclerectomy combined with trabeculectomy in pediatric glaucoma.
OBJECTIVE
To evaluate the outcomes of combined deep sclerectomy and trabeculectomy (penetrating deep sclerectomy) in pediatric glaucoma.


METHODS
Retrospective, nonconsecutive, noncomparative, interventional case series.


METHODS
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.


METHODS
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.


BACKGROUND
The authors have no proprietary or commercial interest in any materials discussed in this article.
Feusier
Michael
M
Glaucoma Unit, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.
Roy
Sylvain
S
Mermoud
André
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000151:congenital / Q000503:physiopathology / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D012189:Retrospective Studies; D012599:Sclerostomy / Q000379:methods*; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology