Risk Factors and Time to Failure of Pediatric Angle Surgeries
Nader M. Mettias; Zeinab S. El Sanabary, MD; Yasmine M. Ahmed, MD; Amanne F. Esmael, MD
Cairo University Hospitals (Kasr Al Ainy)
Introduction: The aim of this study was to determine the risk factors predisposing for failure of goniotomy and trabeculotomy surgeries performed in the Pediatric Ophthalmology department of Cairo University Hospitalsas well as calculate the time to failure.
Methods: This was a retrospective review of records of children aged </=12 years who underwentgoniotomy and /or trabeculotomy from the 1st of January 2013 to 31st of December 2015.With a minimum of 6 months follow up,452 eyes met the inclusion criteria(120 and 332 had goniotomy and trabeculotomy,respectively).Failure was defined as a final IOP>18 mmHg on medications or the need for a subsequent glaucoma procedure.
Results: Failure occurred in 55.8% of eyes that underwent goniotomyand 30.4% of eyes that underwent trabeculotomy,with a mean time to failure of 4.25±3.97 and 6.37±8.25months,respectively. Aniridic and aphakic glaucoma eyes had the worst outcome.Positive consanguinityandhigher preoperative IOP were significant risk factors forfailure in both groups.Larger cup-to-disc ratio wasa specific risk factor for goniotomy(p=0.022)while female gender,opaque corneas and early age at surgery were specific risk factors for trabeculotomy(p=0.002,0.02 and 0.021 respectively).A complete circumferential trabeculotomy showed superior results(p=0.001).
Discussion: Identification of risk factors associated with poorer outcome in pediatric angle surgery can help in guiding the choice of surgery. Failure tends to occur early and is more likely and relatively earlier with goniotomy than with trabeculotomy.
Conclusion: Positive consanguinity and higher preoperativeIOPas well as secondary glaucomas like aniridic and aphakic are poor prognostic factors for angle surgery.Success in trabeculotomy is higher when the extent of the cut is bigger.The early time to failure demands meticulous follow-ups.
References: 1. Al-Hazmi A, Awad A, Zwaan J, Al-Mesfer SA, et al. Correlation between surgical success rate and severity of congenital glaucoma, British Journal of Ophthalmology 2005; 89(4):449–53.
2. Mendicino M E, Lynch MG, Drack A, et al. Long-term surgical and visual outcomes in primary congenital glaucoma: 360° trabeculotomy versus goniotomy, Journal of AAPOS 2000; 4(4):205–10.