Failure of Goniosurgery for Glaucoma Associated with Sturge-Weber Syndrome
Helen H. Yeung, MD; David S. Walton, MD
Introduction: To report the surgical results of goniosurgery (goniotomy or trabeculotomy) for patients with Sturge-Weber Syndrome (SWS) associated glaucoma.
Methods: Retrospective review of patients who had initial goniosurgery for SWS glaucoma (SWSG). The main outcome measure was the postoperative intraocular pressure (IOP) and need for other types of glaucoma surgery.
Results: 42 patients with 46 eyes with SWSG that underwent initial goniosurgery were identified to determine its therapeutic efficacy. The average age at time of goniosurgery was 1.5 years (range: 0.2-23 years). The average preoperative IOP was 35 mm Hg (range: 25-50 mm Hg). 46 eyes underwent goniosurgery with failure rate of 98% (45 of 46 eyes) and qualified success of 2% (1 of 46 eyes). The average interval to failure was 4.0 months (range: 1-48 months).
On gonioscopy, the filtration angles of all operated eyes were all abnormal with variable width and visibility of the ciliary body and less visible scleral spur. The trabecular meshwork was present in 100% of 41 eyes examined, all of which underwent goniosurgery; five eyes underwent goniosurgery without documented gonioscopy. The ciliary body was present in 39% (16) and the scleral spur was visible in 10% (4) of the 41 eyes.
Discussion: Goniosurgery is not an effective initial glaucoma surgery for SWSG. It can temporize the IOP, but ultimately other forms of glaucoma surgery must be considered when surgery is indicated to control the IOP in SWSG patients.
Conclusion: It is clinically imperative to understand the potential failure of initial goniosurgery for SWSG.
References: 1. Patrianakos TD, Nagao K, Walton DS. Surgical management of glaucoma with the Sturge-Weber Syndrome. Int Ophthalmol Clin. 2008;48:63-78.
2. Cibis GW, Tripathi RC, Tripathi BJ. Glaucoma in Sturge-Weber Syndrome. Ophthalmology. 1984;91:1061-1071.
3. Olsen KE, Huang AS, Wright MM. The efficacy of goniotomy/trabeculotomy in early-onset glaucoma associated with Sturge-Weber Syndrome. JAAPOS. 1998;2:365-368.