scholarly journals Axial Length Changes Following Surgical Intervention in Children With Primary Congenital Glaucoma

2021 ◽  
Vol 1 ◽  
Author(s):  
Hind A. Al Dalgan ◽  
Ibrahim A. Al Obaida ◽  
Adi M. Al Owaifeer ◽  
Khabir Ahmad ◽  
Rizwan Malik
Keyword(s):  
Axial Length ◽  
Substantial Reduction ◽  
Glaucoma Surgery ◽  
Mixed Effects ◽  
Congenital Glaucoma ◽  
Primary Congenital Glaucoma ◽  
Post Surgery ◽  
Length Changes ◽  
The Mean

BackgroundPrimary congenital glaucoma (PCG) is a challenging condition to diagnose, treat and effectively monitor. Serial assessment of intraocular pressure (IOP), optic disc cupping, refraction, and axial length (AxL) after surgery are useful to assess disease control. This study aimed to evaluate AxL changes in relation to IOP changes following glaucoma surgery in children with PCG.MethodsWe retrospectively studied AxL changes in children with PCG undergoing surgery. Eyes of children aged ≤ 4 years that did not have prior ocular surgery and that underwent at least one glaucoma surgery during the course of follow-up between June 2014 and July 2018, were included. The effect of change in IOP on change in AxL was estimated using linear mixed effects models.ResultsA total of 105 eyes (of 72 children) with PCG underwent glaucoma surgery representing 26.4% (105/397) eyes. The mean ± SD age of children at baseline was 3.53 ± 4.04 months. At baseline, the mean IOP and AxL were 26.63 ± 9.57 mmHg and 21.67 ± 1.82 mm, respectively. During the course of follow-up post-surgery, the IOP decreased by a mean of 7.25 ± 12.08 mmHg while the AxL increased by a mean of 0.70 ± 1.40 mm. A multivariable mixed effects linear regression revealed that change in AxL was significantly associated with change in IOP (p=0.030) and time since first surgery (p<0.001). A substantial reduction in IOP (≥35 mmHg) was needed at 3 months post-surgery, for AxL to regress.ConclusionIn children with PCG who undergo glaucoma surgery, change in IOP significantly influences change in AxL. For AxL to regress, a substantial reduction in IOP is needed post-surgery.

scholarly journals Microcatheter–Assisted Circumferential Trabeculotomy in Primary Congenital Glaucoma: Long-Term Clinical Outcomes

2022 ◽  
Vol 11 (2) ◽  
pp. 414
Author(s):  
Luigi Fontana ◽  
Alberto Neri
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Glaucoma Surgery ◽  
Congenital Glaucoma ◽  
Primary Congenital Glaucoma ◽  
Age At Surgery ◽  
The Mean ◽  
One Year

Purpose: The purpose of this study was to report the long-term efficacy and clinical outcomes of microcatheter-assisted circumferential trabeculotomy (MCT) in children with primary congenital glaucoma (PCG). Methods: This is a single-center retrospective study including consecutive children with PCG who underwent MCT with > two years follow up. The primary outcome was surgical success, defined as intraocular pressure (IOP) ≤ 21 mmHg with (qualified) or without (complete) medications, measured at six months, one year, and then annually. Secondary outcomes were visual acuity (VA), refraction, axial length (AXL), complications, reinterventions, and number of medications. Results: Twelve eyes of ten patients were included. In eight children only one eye was affected. The mean ± standard deviation (SD) age at surgery was 6.3 ± 4.1 months. The mean postoperative follow-up was 66 ± 35 months. The mean IOP was 34.3 ± 9.6 mmHg preoperatively and 14.6 ± 2.3 mmHg postoperatively at the last visit (p < 0.001). Complete success was achieved at all time points in 10 out of 12 eyes, while 2 eyes had a qualified success. At three years of age, the mean VA of the operated eyes was 0.25 ± 0.12 logMAR, the mean spherical equivalent was −0.78 ± 1.43 diopters, and the mean AXL was 23.78 mm. Transient hyphema was the only complication observed. None of the children required additional glaucoma surgery. Conclusions: Circumferential trabeculotomy for PCG effectively lowers the IOP at more than two years after surgery. Following this procedure, the prognosis for the visual function is good, and the refractive error is low. Postoperative complications were not significant.

Long-term functional outcomes of different subtypes of primary congenital glaucoma

2019 ◽  
pp. bjophthalmol-2019-315131 ◽  
Author(s):  
Richard Sher Chaudhary ◽  
Amisha Gupta ◽  
Ajay Sharma ◽  
Shikha Gupta ◽  
Rayees Ahmad Sofi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Congenital Glaucoma ◽  
Cumulative Probability ◽  
Primary Congenital Glaucoma ◽  
Visual Outcomes ◽  
Post Surgery ◽  
Kaplan Meier ◽  
Significant Difference

AimTo analyse long-term visual outcomes across different subtypes of primary congenital glaucoma (PCG).MethodsPatients with PCG with a minimum of 5-year follow-up post surgery were included in the study. Snellen visual acuity recordings taken at their last follow-up were analysed. We evaluated the results using Kaplan-Meier curves to predict the probability of maintaining good vision (as defined by a visual acuity of 6/18 or better) in our patients after 30-year follow-up. The results were also analysed to determine whether there were any differences in the long-term visual acuities with time between the neonatal and infantile PCG. We also analysed the reasons for poor visual outcomes.ResultsWe assessed a cohort of 140 patients with PCG (235 eyes) with an average follow-up of 127±62.8 months (range 60–400 months). Overall, the proportion of eyes with good visual acuity was 89 (37.9%), those with fair visual acuity between 6/60 and 6/18 was 41 (17.4%), and those with poor visual acuity (≤6/60) was 105 (44.7%). We found a significant difference (p=0.047) between neonatal and infantile patients with PCG whereby the neonatal cohort fared worse off in terms of visual morbidity. On Kaplan-Meier analysis, the cumulative probability of survival of a visual acuity of 6/18 or better was more among the infantile PCG in comparison to the neonatal PCG (p=0.039) eyes, and more among the bilateral than the unilateral affected eyes (p=0.029). Amblyopia was the most important cause for poor visual acuity as shown on a Cox proportional-hazards regression model .ConclusionsLong-term visual outcomes of infantile are better than neonatal PCG. Eyes with unilateral have worse visual outcomes compared with those with bilateral PCG because of the development of dense amblyopia.

Long-Term Visual Outcomes in Children with Primary Congenital Glaucoma

2017 ◽  
Vol 27 (6) ◽  
pp. 705-710 ◽  
Author(s):  
Sanaa A. Yassin
Keyword(s):  
Visual Impairment ◽  
Visual Outcome ◽  
Glaucoma Surgery ◽  
Congenital Glaucoma ◽  
Primary Congenital Glaucoma ◽  
Visual Outcomes ◽  
Antiglaucoma Medication ◽  
Poor Visual Outcome ◽  
The Mean

Purpose To determine the long-term visual outcomes and risk factors for visual loss in children with primary congenital glaucoma (PCG) who underwent angle surgery over a 21-year period. Methods This was a retrospective study of patients who underwent trabeculotomy, trabeculectomy, or combined trabeculotomy-trabeculectomy for PCG. Visual acuity (VA), surgeries, and underlying cause of visual impairment were recorded and compared. Main outcome measures were final best-corrected good VA (20/20 to 20/50), moderate VA (<20/50 to 20/200), or poor VA (<20/200); age at surgery, sex, laterality, type of initial glaucoma surgery, and number of surgeries were recorded. Results Fifty-three eyes were eligible to be included in the study. The mean logMAR VA was 0.61 ± 0.57. A good VA was attained in 51%, moderate VA in 30%, and poor VA in 19%. The main cause of visual impairment with VA <20/50 was deprivation amblyopia (64%). There was no association between VA level and status of success (controlled with or without medications) (p = 0.202). The mean spherical equivalent of refraction was -4.47 ± 5.66; myopia was the predominant refractive error (74%) and astigmatism >2 D (40%). A statistically significant high myopic shift was more frequent in the visually impaired group. None of the studied factors was statistically associated with moderate to poor visual outcome (all p>0.05). Conclusions A favorable VA outcome was achieved. Topical antiglaucoma medication has an adjuvant role in maintaining the success rate of surgery without risking the visual outcome. Corneal opacification and anisometropia were the cause of amblyopia.

scholarly journals Résultats De La Trabéculectomie Dans Le Glaucome Infantile Au Chu Campus De Lomé (Togo)

2017 ◽  
Vol 13 (12) ◽  
pp. 119
Author(s):  
Nidain Maneh ◽  
Kokou Vonor ◽  
Bénédicte Marèbe Diatewa ◽  
Nonon Saa Kassoula Batomaguela ◽  
Kokou Messan Amedomé ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Substantial Reduction ◽  
Congenital Glaucoma ◽  
Pressure Reduction ◽  
Topical Medication ◽  
Surgical Success ◽  
Target Pressure ◽  
The Mean

Purpose: To evaluate the results of the trabeculectomy without antimitotic in children aged 5 to 15 years and identify the factors of success of this technique. Method: we have conducted a retrospective study based on records of children of 5 to 15 years, operated from January 2011 to December 2013 for glaucoma excepted congenital glaucoma. The trabeculectomy was performed without antimitotic and the follow up was done during 6 months. Nineteen children (35 eyes) were included over 23 children (43 eyes) operated. Surgical success was defined for intra ocular (IOP) ≤ 20mmhg (target pressure) pressure associated with a pressure reduction over 30% with or without topical medication and major postoperative complications. Results: On the 19 included Sham children (35 eyes) the mean age was 9.05 years [5;15], 11 were of boys and 8 girls and the sex ratio was 0.73. The mean cup/disc of the papillary excavation was 0.54 [0.2; 0.8]. The mean preoperative IOP was 20.08 mm Hg [11;30]. Postoperative complications was seen in 17% (6 eyes) with 11.4% (4 eyes) of hypothalamy. The mean post operative IOP at 6 months was 12.86 mm Hg [10; 23]. The success rate was 62.86% (22 eyes). IOP control was the only factor influencing the success of surgery (p = 0. 0055). Conclusion: The trabeculectomy without antimitotic allowed a substantial reduction in IOP. The control of IOP determine the success of the surgery at 6 months. The spreading of the technique with the use of an antimitotic will optimize our results.

scholarly journals The relationship between axial length, age and intraocular pressure in children with primary congenital glaucoma

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ibrahim Al-Obaida ◽  
Adi Mohammed Al Owaifeer ◽  
Khabir Ahmad ◽  
Rizwan Malik
Keyword(s):  
Intraocular Pressure ◽  
Axial Length ◽  
Care Facility ◽  
Glaucoma Surgery ◽  
Clinical Parameter ◽  
Congenital Glaucoma ◽  
Primary Congenital Glaucoma ◽  
Number Of Children ◽  
Predicted Values ◽  
The Relationship

Abstract Whilst axial length (AxL) from ultrasound examination is a useful clinical parameter for monitoring progression in younger children with glaucoma, distinguishing AxL changes due to raised intraocular pressure (IOP) from age is often challenging. Existing normograms have included a limited number of children with glaucoma. The aim of this study was to evaluate the relationship between AxL with age and IOP in children with primary congenital glaucoma (PCG) and develop a model for expected AxL increase with age. All children (n = 208; 397 eyes) with PCG who attended our tertiary eye care facility from June 2014 and July 2018 and had AxL and IOP measurements were included. The relationship of AxL with age and IOP was studied by applying a LOWESS fit and then mixed effects models. In the final model, age was the most significant factor influencing the growth of AxL (coefficient age 3.14[95% CI 2.91–3.35, p < 0.001], coefficient age2 − 0.53[95% CI, − 0.59 to − 0.47, p < 0.001]), and this association was influenced by the interaction of IOP with sex (p = 0.098 for girls relative to boys), the number of antiglaucoma medications (AGM [p < 0.001 for ≥ 3 AGM]) and glaucoma surgery (p = 0.015). This model enabled us to derive predicted values for clinical use in children with PCG to predict those with progressive glaucoma.

scholarly journals The Epidemiological and Clinical Findings from the Latvian Registry of Primary Congenital Glaucoma and Evaluation of Prognostic Factors

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 44
Author(s):  
Eva Elksne ◽  
Kristine Baumane ◽  
Arturs Ozolins ◽  
Sandra Valeina
Keyword(s):  
Prognostic Factors ◽  
Relative Risk ◽  
Diagnostic Delay ◽  
Congenital Glaucoma ◽  
Tertiary Referral Centre ◽  
Primary Congenital Glaucoma ◽  
Male Predominance ◽  
Live Births ◽  
The Mean

Background and objectives: primary congenital glaucoma (PCG) is a rare, potentially blinding disease that affects children worldwide. The aim of the study was to describe the epidemiological and clinical characteristics, outcomes for newly diagnosed patients with PCG, as well as evaluate the prognostic factors that are related to the outcomes. Materials and Methods: a retrospective cohort study was conducted at a tertiary referral centre among patients diagnosed with PCG. Evaluation of the clinical data was performed preoperatively at three, six, and 12 months after the surgery and at the last follow-up. Results: during the 15 years of follow-ups, 24 eyes of 18 patients were diagnosed with PCG. Unilateral and bilateral PCG constituted 50% of cases each. A slight male predominance was observed (55.6% vs. 44.4%), with a relative risk of 1.3. The incidence of PCG was 1:19,033 live births. The mean age of the patients at the time of diagnosis was 10.1 ± 10.0 months, with a diagnostic delay of 2.0 ± 1.9 months. Furthermore, 75% of patients indicated an enlargement of an eyeball, followed by excessive tearing (58.3%) and corneal opacity (41.7%). After 85.9 ± 51.2 months, the mean intraocular pressure (IOP) value was 14.6 ± 4.9 mmHg. Surgical treatment provided sufficient IOP control in 75% of PCG cases at the last follow-up visit. The only prognostic factor that was related to the outcome of IOP control that was statistically significant was axial length at the time of diagnosis. Conclusions: the incidence of PCG in Latvia was 5.3 patients per 100,000 live births. PCG was more common among males than females with a relative risk of 1.3. The enlargement of an eyeball was the leading clinical sign.

scholarly journals Combined trabeculotomy-trabeculectomy with antimetabolite and releasable suture: outcome with primary congenital glaucoma in a north Indian population

2015 ◽  
Vol 7 (1) ◽  
pp. 16-25 ◽  
Author(s):  
S Dubey ◽  
A Agrawal ◽  
L Chauhan ◽  
S Mukherjee ◽  
G Douglas
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Indian Population ◽  
Case Series ◽  
Congenital Glaucoma ◽  
North Indian Population ◽  
Success Rates ◽  
Primary Congenital Glaucoma ◽  
The Mean

Objective: To determine the surgical outcomes of combined trabeculotomy- trabeculectomy with mitomycin-C and releasable suture in children with primary congenital glaucoma (PCG) in a North Indian population. Design: Retrospective, interventional, consecutive, non-comparative case series. Materials and methods: The medical records of 137 eyes of 77 patients who underwent combined trabeculotomy- trabeculectomy with 0.2 mg/ml mitomycin C (MMC) either bilaterally (49 patients) or unilaterally (28 patients) between January 2004 and March 2012 were reviewed retrospectively. The main outcome measures were postoperative intraocular pressures, corneal clarity and diameter, duration of follow-up, success rate and complications. Results: The mean preoperative intraocular pressure reduced from 34 ± 7 mm Hg (range 15- 54 mm Hg) to 17 ± 7 mm Hg (range 5 - 32 mm Hg) with a mean reduction of 44 % (P < 0.001). The mean follow-up period was 24.4 ± 10.3 months (range 6 – 48 months). Complete success defined as intraocular pressure < 21 mm Hg without any medication and clinically stable glaucoma at last follow-up was achieved in 113 eyes (83 %) while a ‘quali¿ed success’ of intraocular pressure < 21 mm Hg with one medication was achieved in ten eyes (7 %). The Kaplan-Meier survival analysis revealed success rates (at ‘n’ months) of 90 % (6), 85 % (12), 82 % (24), 80 % (36) and 77 % (48). There were no signi¿cant intraoperative or postoperative complications.Conclusion: Primary combined trabeculotomy-trabeculectomy with mitomycin-C and releasable suture offers a viable surgical option in Northern Indian infants with primary congenital glaucoma. The use of 0.2 mg/ml mitomycin C for 2 minutes improves the overall success while the releasable suture decreases the risk of postoperative complications especially associated with the use of antimetabolites.

Ab interno 180-degree trabeculectomy with a dual blade in a patient with refractory primary congenital glaucoma

2021 ◽  
pp. 112067212110104
Author(s):  
Mehmet Talay Koylu ◽  
Fatih Mehmet Mutlu ◽  
Alper Can Yilmaz
Keyword(s):  
Intraocular Pressure ◽  
Female Patient ◽  
Congenital Glaucoma ◽  
Safe Procedure ◽  
Primary Congenital Glaucoma ◽  
History Of ◽  
Kahook Dual Blade ◽  
The Right ◽  
Ab Interno

A 13-year-old female patient with refractory primary congenital glaucoma (PCG) in the right eye who had a history of multiple glaucoma operations underwent ab interno 180-degree trabeculectomy with the Kahook Dual Blade (KDB) targeting the nasal and inferior angles. On postoperative day 1, the intraocular pressure (IOP) of the right eye reduced from 43 to 15 mmHg while on medical therapy. The patient maintained this IOP level throughout the 6-month follow-up. Ab interno KDB trabeculectomy targeting both nasal and inferior angles may be an effective and safe procedure for the treatment of PCG even in eyes with a history of previously failed glaucoma procedures.

scholarly journals Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

2009 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Marcus Jaeger ◽  
Michael Schmidt ◽  
Alexander Wild ◽  
Bernd Bittersohl ◽  
Susanne Courtois ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Mean Value ◽  
Surgical Approaches ◽  
Radiological Outcome ◽  
Scarf Osteotomy ◽  
Post Surgery ◽  
The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23&deg;; increased proximal articular angle (PAA&gt;8&deg;), and range of motion of the metatarsophalangeal joint in flexion and extension &gt;40&deg;. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8&plusmn;1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7&plusmn;2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1&plusmn;2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6&deg; (pre-operative mean value: 37.5&deg;) which was statistically significant (p&lt;0.01). The IMA improved by an average of 5.96&deg; from a pre-operative mean value of 15.4&deg; (p&lt;0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

Factors affecting changes in the intraocular pressure after phacoemulsification surgery

2020 ◽  
Vol 1 (3) ◽  
pp. 166-172
Author(s):  
Rita Dhamankar ◽  
◽  
Suhas S Haldipurkar ◽  
Tanvi Haldipurkar ◽  
Vijay Shetty ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Axial Length ◽  
Anterior Chamber Depth ◽  
The Other ◽  
Factors Affecting ◽  
Factors Associated ◽  
Post Surgery ◽  
Unit Increase ◽  
The Mean

AIM: To assess the changes in anterior chamber parameters and examine the factors associated with changes in the intraocular pressure (IOP) in individuals who have undergone phacoemulsification surgery. METHODS: It is a longitudinal analysis of secondary clinical data collected from 105 non-glaucomatous eyes (82 patients) undergoing a cataract surgery. We studied the association between anterior chamber parameters, grade of cataract, demographics, and changes in the IOP over a period of three weeks. We also evaluated the association between the pressure-depth (PD) ratio and changes in the IOP during this time. RESULTS: The mean age (SD) of the 82 patients was 60.1±7.8y. The mean±standard deviation (SD) IOP was 15.06±3.36 mm Hg pre-operatively; it increased to 15.75±4.21 mm Hg on day one (P=0.20). In the multifactorial models, the mean IOP was -1.715 (95%CI: -2.795, -0.636) mm Hg on day 21±5 compared with the pre-operative values. The anterior chamber depth (ACD), axial length, age, sex, and grade of cataract were not significantly associated with changes in the IOP. Each unit increase in the PD ratio was associated with an increase in the mean IOP by 1.289 mm Hg (95%CI: 0.906, 1.671). After adjusting for pre-operative PD ratio, none of the other variables (ACD, axial length, temporal angle) were significantly associated with changes in mean IOP. CONCLUSION: The PD ratio was the single most important factor associated with the changes in post-operative IOP over three weeks post-surgery.

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