Outcomes of adjusted trabeculotomy in cases with juvenile glaucoma
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GLAUCOMA
Outcomes of adjusted trabeculotomy in cases with juvenile glaucoma Ahmad K. Khalil 1,2 Received: 23 July 2020 / Revised: 14 October 2020 / Accepted: 30 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate surgical and visual outcomes of modified adjusted trabeculotomy in juvenile glaucoma (JG) cases. Methods A retrospective case series; medical records of 43 patients (69 eyes) JG cases operated by adjusted trabeculotomy between 2011 and 2018. Those who completed a minimum of 1 year of regular follow-up, and up to 5 years were included in the study. Intraocular pressure (IOP), number of medications, cup/disc ratio (CDR), and visual acuity (VA) at baseline, postoperative 1, 3, 5 years were evaluated. Success required IOP ≤ 18 mmHg and a minimum of 20% reduction, without medications (full), or with medications (qualified). Results Numbers of patients (eyes) who completed 1, 3, and 5 follow-up years were as follows: 26 (43), 15 (27), and 11 (19). Median (range) age at surgery was 21.5 (8–43) years. Mean (range) IOP was significantly (P < .001) reduced from 23.4 ± 8.8 (11.0–46.0) mmHg to 11.5 ± 3.5 (7.0–28.0), 10.9 ± 3.6 (6.0–24.0), and 11.4 ± 3.0 (7.0–17.0) mmHg at 1, 3, and 5 years, with reduction of medication scores. At years 1, 3, and 5, complete success rates were 89.5%, 86.8%, and 89.5%, and qualified success rates were 97.4%, 94.7%, and 97.4%. Median (range) LogMAR VA significantly (P < .001) improved from 0.3 (0–2.8) to 0.17 (0–2.8) and 0.17 (0–2.8) at 1 and 5 years. Median (range) CDR was significantly (P < .001) reduced from 0.85 (0.3–1.0) to 0.85 (0.1–1.0), 0.7 (0.05–1.0), and 0.7 (0.05–0.9) at 1, 3, and 5 years. Conclusions Adjusted trabeculotomy could effect remarkable IOP lowering for up to 5 years postoperatively in JG eyes, and seems to be an effective, low-risk surgical modality for treating such eyes. It can be associated with cupping reversibility, and visual improvement on the long-term. Good surgical technique and postoperative care are imperative to achieve a successful outcome.
Key Messages: What is known: Trabeculotomy in adult eyes is a safe but weak surgery which does not result in significant IOP lowering and can be useful for mild-moderate IOP elevations. Modified adjusted trabeculotomy is a low-risk, not-highly-invasive surgical modality that can result in persistent IOP lowering to low teens regardless of the preoperative IOP through 5 years of follow up, when performed in adult eyes up to 43 years of age, including black patients. Surgery can effect optic disc cupping reversibility with improvement of visual acuity in some cases. Keywords Glaucoma . Juvenile . Surgery . Trabeculotomy
Introduction * Ahmad K. Khalil [email protected] 1
Research Institute of Ophthalmology, 2 Al-Ahram St., Giza, Egypt
2
Egyptian Society for the Glaucomas, Cairo, Egypt
The first known mention of angle surgery came in 1891 by De Vincentiis in Italy, who described “incision of the iridic angle” for treating his glaucoma patients [1, 2]. The t
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