Outcome of angle surgery in children with aphakic glaucoma.
OBJECTIVE
To investigate the outcome of trabeculotomy and/or goniotomy for pediatric aphakic glaucoma.


METHODS
Retrospective chart review of consecutive children who had congenital cataract surgery between 1990 and 2006 and required goniotomy and/or trabeculotomy for aphakic glaucoma. Treatment success was defined as postoperative intraocular pressure of <or=24 mm Hg despite topical medication use, avoidance of trabeculectomy or shunt placement, and no visually significant complications in the follow-up period. Exclusion criteria included a diagnosis of anterior segment dysgenesis, microcornea, and glaucoma at the time of cataract surgery, and follow-up less than 1 year.


RESULTS
A total of 14 eyes of 11 patients met inclusion criteria, with a mean follow-up of 4.7 years. Of theses, 2 eyes had goniotomy alone, 3 eyes had goniotomy followed by trabeculotomy, and 9 eyes had trabeculotomy alone. Mean IOP before angle surgery was 35 +/- 10 mm Hg. Mean IOP at the last recorded visit was 22 +/- 4 mm Hg (p = 0.0005). Treatment success was observed in 8 of the 14 eyes (57.1%), with a mean number of angle procedures of 1.4 per eye: 6 eyes (42.8%) were successful after a single angle surgery, each involving an initial trabeculotomy; 3 eyes (21.4%) underwent subsequent shunt placement after initial goniotomy at 6 months, 1.3 years, and 5.5 years after the last angle surgery.


CONCLUSIONS
When intraocular surgery is indicated to control IOP in pediatric aphakic glaucoma, trabeculotomy and/or goniotomy can be successful in the majority of eyes and may decrease the need for filtering and shunting procedures.
Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota 55455-5501, USA. bothu003@umn.edu
Erick D
ED
Bothun
Yan
Y
Guo
Stephen P
SP
Christiansen
C Gail
CG
Summers
Jill S
JS
Anderson
Martha M
MM
Wright
Natalia Y
NY
Kramarevsky
Mary G
MG
Lawrence
D001036:Aphakia, Postcataract / Q000601:surgery*; D002386:Cataract / Q000151:congenital*; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D014130:Trabeculectomy; D016896:Treatment Outcome