Glaucoma surgery results in infants and newborns are promising, with high rates of surgical success in both congenital and secondary glaucoma, according to a study published in Acta Ophthalmologica. In a retrospective cohort study of 79 eyes of 52 children with glaucoma, surgery success was high — and appeared highest with 360° catheter-assisted trabeculotomy compared with other surgical approaches.

The occurrence of glaucoma in newborns and children is considered rare. Very few centers in the world focus on the management of newborns and children with glaucoma. Currently, the most common form of treatment for primary congenital glaucoma is conventional trabeculotomy. However, 360° catheter-assisted trabeculotomy has emerged as competition in primary intervention, according to the study.

Researchers from the University Medical Center Mainz, in Germany, examined the long-term results of glaucoma surgery in newborn and children with glaucoma. They analyzed data on 79 eyes of 52 children (age range: 3 weeks to 15.3 years, 28 girls) with primary congenital or secondary glaucoma treated between 2015 and 2017. The median follow-up time was 3.9 years and the primary study outcome was surgical success.


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The following surgical approaches were compared: conventional probe trabeculotomy, 360° catheter-assisted trabeculotomy, filtering and cyclodestructive surgery. The investigators evaluated complete surgical success — defined as achieving below target intraocular pressure (IOP), and requiring no further surgery — and incomplete surgical success, which required additional surgery. They compared IOP at baseline with the last follow-up.

The researchers found that IOP was significantly reduced in primary congenital glaucoma (preoperative IOP: 27.8+7.5 mm Hg vs postoperative IOP: 14.2+4.5 mm Hg) and secondary glaucoma (preoperative IOP: 29.2+9.1 mm Hg vs postoperative IOP: 16.6+4.7 mm Hg).

In all eyes, 90% achieved target IOP with or without medication allowing for further surgeries.

According to investigators, 360° catheter-assisted trabeculotomy seemed to have higher surgical success compared with other surgical approaches. In contrast, cyclodestructive procedures had the lowest surgical success.

Due to its low success rate, cyclodestructive approaches “should not be considered as favorable option for surgical first-line treatment,” according to investigators. 

This study noted some limitations. Due to data being collected retrospectively, follow-up data could not be collected for all patients. Additionally, only 32 eyes were included in corneal diameter evaluation.

“We found very promising surgical results in our childhood glaucoma patient group,” researchers report. “Meanwhile, 360° trabeculotomy has become our preferred surgical treatment option and further evaluation of this surgical approach will give more insight into success rates compared to probe trabeculotomy.”

Reference   

Hoffmann EM, Aghayeva F, Schuster AK, et al. Results of childhood glaucoma surgery over a long-term period. Acta Ophthalmol. Published online August 6, 2021. doi:10.1111/aos.14985