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HAILONG HUANG, wenjun bao, Kazuhide Kawase, Tetsuya Yamamoto; Long-term postoperative outcome for childhood glaucoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4973.
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To investigate the long-term postoperative outcome of childhood glaucoma and to compare the efficacy of the three surgical procedures for it.
Selected from our patient database were cases with various types of childhood glaucoma in which goniotomy, trabeculotomy, or a filtration surgery (trabeculectomy or thermal sclerostomy) was performed as the initial surgery at our hospital during the period from 1985 to 2010. The Kaplan-Meier analysis was employed to calculate the intraocular pressure (IOP) control. In addition, IOP changes, numbers of additional surgery, eye drop scores, final visual acuity, final IOP were analyzed with Steel-Dwass test.
Fifty-four eyes of 32 patients, 27 eyes of 17 patients and 12 eyes of 8 patients were selected in the goniotomy group, the trabeculotomy group and the filtration surgery group, respectively. The Kaplan-Meier analysis estimated that the probability of successful IOP control was 75.5 ± 9.9%, 67.4 ± 10.2% and 78.4 ± 12.1% (cumulative probability ± standard error) at 20-year follow-up for the goniotomy group, the trabeculotomy group and the filtration surgery group, respectively, when surgical failure was defined as IOP≥ 21 mmHg with/without medications (p=0.130: log-rank test). The final IOP was significantly lower in the filtration surgery group than in the trabeculotomy group (p = 0.008). The final IOP was significantly reduced in all groups when compared with preoperative value (p ≤ 0.001: Wilcoxon signed-rank test). Additional surgery was significantly less in the filtration surgery group than in the trabeculotomy group (p = 0.035). The final medication score was significantly higher in the trabeculotomy group than in the other two groups (p <0.001). The final visual acuity was significantly lower in the filtration surgery group than in the other groups (p = 0.010 and <0.001 for goniotomy and trabeculotomy, respectively).
The three surgical procedures can maintain the IOP in 67.4-78.4% of childhood glaucoma less than 21mmHg for up to 20 years. Filtration surgery, however, results in fewer additional operations, lower medication scores and lower final IOP than does trabeculotomy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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