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Elena Bitrian, Alana L Grajewski; Surgical Outcomes of Congenital Glaucoma in Peters' Anomaly. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2735.
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To evaluate the long term efficacy of intraocular pressure (IOP) reduction in children with Peters' anomaly and congenital glaucoma undergoing trabeculotomy and glaucoma shunt implants.
This is a retrospective case series of patients with Peters' anomaly and congenital glaucoma from one single academic institution. The medical records of patients with more than 3 years of follow-up were reviewed. Clinical characteristics, medical and surgical treatments, IOP and visual acuity (VA) were collected.
Eleven eyes of 6 patients with Peters’ and congenital glaucoma were followed for an average of 7 years, range 3.8-12 years. Four of the patients were females. Five cases were bilateral. All the eyes had corneal opacities and different degrees of cataracts. Two patients had Peters' plus disease, one had severe developmental delay and another moderate delay. The patients underwent a total of 6 trabeculotomies, 5 Baerveldt implants, 4 cataract extractions (2 with intraocular lens implant and 2 were left aphakic), 4 penetrating keratoplasties and 3 sector iridectomies.Two of the patients with penetrating keratoplasties had graft failure. Three patients had both a trabeculotomy and a Baerveldt implant. The trabeculectomy was successful in controlling IOP for 6-11 months. After this, IOP increased and the patients underwent a Baerveldt implant surgery. In one patient a Baerveldt implant was performed assisted by endoscopic visualization due to the severe corneal opacity.<br /> The final mean IOP was 16.82 mmHg (range 10-21 mmHg). VA at the end of follow-up was count fingers or worse in 5 of the 11 eyes and VA equal or worse than 20/100 in 9 of the 11 eyes. One eye had VA of 20/70 and another patient was fix and follows due to developmental delay. Five of the 6 patients were on glaucoma drops at the end of follow-up.
Peters' anomaly represents a challenge for the pediatric, anterior segment and glaucoma specialists. Glaucoma surgery and medical therapy combined can result in an adequate control of IOP in Peters' anomaly. Angle surgery can be successful temporarilly, but eyes with Peters' and congenital glaucoma often need a glaucoma drainage device. The visual results are poor due to anterior segment abnormalities, amblyopia and glaucoma.
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