Abstract
Purpose :
Glaucoma is rare in childhood. Goniotomy surgery is attractive since it is conjunctival-sparing, quick and relatively safe. We have used this technique across the whole spectrum of childhood glaucoma and report its long-term results for each condition.
Methods :
We reviewed the charts of all children undergoing goniotomy from 2000 to 2018. Exclusion criteria were: any previous glaucoma surgery and follow-up < 6 months. We defined complete success as final intraocular pressure (IOP) </=21 mm Hg after one or two goniotomies without medications, qualified success as IOP </= 21 mm Hg with medications and failure as IOP > 21 mm Hg despite medical therapy, requiring further surgery.
Results :
90 eyes of 61 patients which had undergone goniotomy were included. Mean age at surgery was 5.1 ± 4.8 years (range 37 days to 15.7 years, median 2.7 years). 34 eyes had a diagnosis of Primary Congenital Glaucoma (PCG), 16 of Juvenile open angle glaucoma (JOAG), 18 of Uveitic Glaucoma, 11 of Anterior Segment dysgenesis or Aniridia, 7 of Sturge Weber (SWS) or Klippel Trenaunay Weber Syndrome, and 4 of Aphakia. Mean follow up was 6.6 ± 4.4 years (Range 0.5 to 17 years).
At last follow-up 52 eyes (58%) achieved complete success after 1 or 2 goniotomies, 8 eyes (9%) achieved qualified success and 33% were classed goniotomy failures. Complete success per diagnosis was as follows: PCG:85%, JOAG:31%, Uveitic glaucoma:67%, SWS / Klippel Trenaunay:0%, Anterior Segment Dysgenesis / Aniridia:45% and Aphakia:25%. When combining complete and partial success for PCG, JOAG and Uveitis the percentages were 88%, 62% and 77%. One infant with PCG with unsuspected bleeding diathesis required surgical hyphema evacuation.
Conclusions :
Goniotomy is effective and safe for the treatment of PCG and uveitic glaucoma in our population. It was also a qualified success for many JOAG and aniridia or ASD patients. It was not effective for aphakic glaucoma or SWS / Klippel –Trenaunay syndrome. Long-term survival analysis showed goniotomy results to be largely stable after the first 6-month post-operatively. NeverthelessnCareful long-term follow-up remains indicated.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.