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S. V. Kulkarni, K. F. Damji, A. V. Fournier, Y. I. Pan, W. G. Hodge; Endoscopic Goniotomy: Clinical Experience in Congenital Glaucoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4169.
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To evaluate the early surgical outcomes and safety of Endoscopic Goniotomy (EG) in children with opaque corneas and primary congenital glaucoma (PCG) or developmental glaucoma with ocular or systemic anomalies (DGA).
A single center, cohort study of patients who underwent EG between 2003-2007 at the Children’s Hospital of Eastern Ontario (CHEO) was performed. The 20g endoscope (Endoptiks) permitted excellent visualization of anterior chamber angle details and 300º goniotomy was performed via 2 sites (temporal and superonasal) using adjacent ports for the endoscope and a 25g needle. The primary outcome measure was IOP change from baseline. Secondary outcomes included horizontal and vertical corneal diameter, axial length, vertical cup/disc ratio, success rate using Kaplan Meier (K-M) analysis and complications. Success was defined as IOP lowering from baseline IOP (noted on the day of surgery when patients were already on glaucoma medication) with or without additional medications but no further surgical intervention.
A total of 14 eyes of 8 consecutive patients (6 males, 2 females) were enrolled including 4 patients with PCG, 2 with aniridia and 1 each with Rubinstein-Taybi syndrome and neurofibromatosis. The mean age at surgery was 3.81 ± 3.72 months (range= 0.5-11 months). The average follow-up was 11.75 ± 6.23 months. During this period, corneal diameter, axial length and cup disc ratio remained stable in all eyes; however IOP changes were variable. K-M analysis showed an overall success of 41.9% over 24 months (PCG 50%, DGA 35%). 2 patients with DGA needed additional surgery at 8-9 months post EG. Cataract and zonular dialysis were noted in 2 patients with aniridia.
The endoscope is a safe and promising device facilitating goniotomy in childhood glaucoma with surgically cloudy corneas by providing illumination and a clear view of angle structures. Our early results show that IOP control following EG is better in eyes with PCG than DGA. A larger sample size and comparison to other angle surgery techniques are needed to further study and understand the value of this procedure.
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