A comparative study on surgical outcomes of trabeculectomy with and without anti-metabolites in juvenile open-angle glaucoma

Purpose: To compare the surgical outcomes of trabeculectomy with and without anti?metabolites in patients with juvenile open?angle glaucoma (JOAG). Methods: This retrospective comparative case series included 98 eyes of 66 patients with JOAG who underwent either trabeculectomy without anti?metabolites (group A, n = 53 eyes) or with anti?metabolites (group B, n = 45 eyes) with a minimum of 2 years follow?up. The main outcome measures were intra?ocular pressure (IOP), number of glaucoma medications, visual acuity, additional surgical interventions, surgical complications, and risk factors for failure. Surgical failure was defined as IOP >18 mmHg or failure to reduce IOP by <30% from the baseline value or IOP ?5 mmHg or re?operation for refractory glaucoma or a complication or loss of light perception vision. Results: The mean post?operative IOP reduced significantly from baseline at all post?operative visits until 6 months and thereafter. The cumulative probability of failure at 2 years was 28.7% in group A [95% confidence interval (CI) = 17.6–44.8%] and 29.1% in group B (95% CI = 17.1–46.7%) (P = 0.78). Surgical complications occurred in 18 eyes (34%) in group A and 19 eyes (42%) in group B. Re?operations for glaucoma or complications were performed in two eyes (3.8%) in group A and two eyes (4.4%) in group B. Cox?hazard regression model revealed male gender (HR = 0.29; P = 0.008), baseline high IOP (HR = 0.95; P = 0.002), and an increased number of pre?operative glaucoma medications (HR = 2.08; P = 0.010) as significant factors associated with failure. Conclusion: Our study results on trabeculectomy in JOAG revealed a success of 71% in both groups at 2 years follow?up. There was no significant difference in success or failure rates between the two groups. The risk factors for poor surgical outcome in JOAG were male gender, baseline high IOP, and an increased number of glaucoma medications

Outcomes of trabeculectomy in juvenile open angle glaucoma.

Purpose: This study was aimed at reporting the outcomes of trabeculectomy in primary juvenile open angle glaucoma (JOAG). Design: This study was a retrospective noncomparative case series. Materials and Methods: We included 60 eyes of 41 JOAG patients who underwent primary trabeculectomy without mitomycin-C (MMC) between 1995 and 2007. The primary outcome was success, defined as complete, if intraocular pressure (IOP) was >5 and ≤21 mmHg without medications or qualified if IOP was >5 and ≤21 mmHg with or without antiglaucoma medications. Secondary outcome measures were mean and percentage IOP reduction, complications, and risk factors for the failure of trabeculectomy. Results: The mean (±standard deviation) age at presentation was 24.1 ± 6.8 years (range, 12–35). Mean follow-up was 67 ± 41 months (range, 12–156). At 1 year, the probability of complete success was 92% (n = 56, 95% CI: 81–96%), at 3 years it was 89% (n = 47, 95% CI: 78–95%), and at the end of 5 years, it was 80% (n = 34, 95% CI: 65–89%). The probability of qualified success was 100% (n = 60) at 1 year, 98% (n = 51, 95% CI: 87–100%) at 3 years, and 96% (n = 36, 95% CI: 84–99%) at the end of 5 years. The mean IOP reduced from 35 ± 10 to 13 ± 2.5 mmHg (P < 0.001) after trabeculectomy. There was no serious postoperative complication. Young age was the only significant risk factor associated with the failure (odds ratio = 0.89, P = 0.03). Conclusion: Primary trabeculectomy without MMC has good success rates in JOAG.

Determinants of severity at presentation among young patients with early onset glaucoma.

Aim: The aim of this study was to evaluate the clinical, socio‑economic, and demographic factors associated with the severity at presentation among juvenile primary open angle glaucoma (JOAG) patients. Materials and Methods: Age at diagnosis, family history, baseline intraocular pressure (IOP), access to health‑care, socio‑economic status, and glaucoma awareness among 80 unrelated JOAG patients presenting between 10 years and 40 years of age were analyzed for their association with the severity at presentation. Severity at presentation was graded based on worse eye visual field using the advanced glaucoma intervention study score and on binocular visual field defects at presentation. Results: Patients with a positive family history presented 4 years earlier (P = 0.045, confidence interval [CI]: 0.09‑8.8) compared to those without a family history. Lower socio‑economic status (Odds ratio [OR] 5.7, P = 0.01, CI: 1.5‑22), and higher baseline IOP (OR 7, P = 0.003, CI: 1.9‑26) were associated with severe glaucomatous visual field defect at presentation. A negative family history was associated with a 10 times likelihood of presenting with a severe glaucomatous field defect (OR 0.1, P = 0.007, CI: 0‑0.5). Conclusions: Clinical, socio‑economic, and demographic factors are contributory to the severity at presentation among young patients with early onset glaucoma. Presence of a family history is associated with an earlier presentation among these patients and a reduced risk of the severe presentation

Caracterización del glaucoma juvenil / Characterization of juvenile glaucoma

INTRODUCCIÓN. El glaucoma no es frecuente en los niños, pero cuando ocurre sus síntomas son poco perceptibles y produce graves consecuencias para la salud visual. El objetivo de este estudio fue caracterizar, desde las aristas clínica y epidemiológica, a los pacientes con glaucoma juvenil atendidos en los servicios de oftalmología de los Hospitales Pediátricos del Cerro y Pedro Borrás, en Ciudad de La Habana, en el período comprendido entre enero de 2008 y diciembre de 2009. MÉTODOS. Se realizó un estudio epidemiológico longitudinal y prospectivo, cuyo universo estuvo constituido por 176 pacientes entre 5 y 18 años de edad, con presunto glaucoma. La muestra, despues de aplicados los criterios de inclusión y exclusión, quedó conformada por 38 casos. Se analizaron las variables: edad al momento del diagnóstico, sexo, color de la piel, antecedentes familiares según grado de parentesco, agudeza visual máxima corregida, tipo de defecto refractivo, características del ángulo camerular, espesor corneal central, valor de la presión intraocular, alteraciones fundoscópicas y campimétricas. RESULTADOS. En la mayoría de los pacientes el diagnóstico de glaucoma juvenil constituyó un hallazgo. La mediana de edad al momento del diagnóstico fue de 12,5 años, con ligero predominio de varones y de la piel no blanca. Fue más frecuente el antecedente de glaucoma en familiares de segundo grado de consanguinidad. La mayoría de los casos tenía visión óptima, algún grado de miopía y ángulo abierto sin alteraciones evidentes del ángulo camerular, entre las cuales la más frecuente fue la presencia de procesos iridianos prominentes. CONCLUSIONES. Predominaron la disminución moderada del espesor corneal y valores medios de presión intraocular de 26,91 mm Hg. La alteración fundoscópica encontrada con mayor frecuencia fue la excavación papilar moderada (entre 0,4 y 0,5) y como lesión campimétrica, el aumento de la mancha ciega

INTRODUCTION. The glaucoma is infrequent in children but when it is present symptoms are not easily noticeable and produce severe consequences for visual health. The aim of present study was to characterize, from the clinical and epidemiologic point of view, the patients presenting with juvenile glaucoma seen in Ophthalmology services of the Cerro and Pedro Borrás Children Hospitals in Ciudad de La Habana from January, 2008 to December, 2009. METHODS. A prospective, longitudinal and epidemiologic study was conducted in 176 patients aged between 5 and 18 with a supposed glaucoma. Sample, after applied the inclusion and exclusion criteria, included 38 cases. Variables analyzed were: age at diagnosis, sex, skin color, family backgrounds according the relationship grade, corrected maximal visual acuity, type of refractive defect, characteristics of cell angle, central corneal thickness, the value of intraocular pressure, fundoscopy and campimetry alterations. RESULTS. In most of patients the diagnosis of juvenile glaucoma was a finding. The mean age at diagnosis was of 12,5 years, with slight predominance of males and of white skin color. The history of glaucoma in second grade blood relation relatives was more frequent. Most of cases had an optimal vision, some degree of myopia and open angle without obvious of cell angle where the more frequent was the presence of prominent iridic processes. CONCLUSIONS. There was predominance of a moderate decrease of corneal thickness and mean values of intraocular pressure of 26,91 mm Hg. The more frequent fundoscopy alteration found was the moderate papillary excavation (between 0,4 and 0,5) and as campimetry lesion, it was the increase in the black spot.

Long-term Surgical Outcome of Juvenile Glucoma

PURPOSE: To report the surgical outcome of juvenile glaucoma who had filtering surgery with Mitomycin C (MMC). METHODS: We have studied 38 patients (42 eyes, respectively) who were diagnosed as primary open angle glaucoma (31 patients), secondary open angle glaucoma (6 patients) and primary angle closure glaucoma (1 patients). The patients have been followed up for 24 months. RESULTS: Of total 42 eyes, 32 eyes had trabeculectomy only and the other 10 eyes had combined trabeculectomy and trabeculotomy. Mean preoperative intraocular pressure (IOP) was 34.4+/-12.0 mmHg, which was dropped to 13.3+/-4.0 mmHg postoperatively. There were statistically significant drop of IOP after filtering operation (P<0.05). However, success rate between group of age 10-25 and group of age 26-40 was not significantly different (90.5%, 76.2%, respectively). CONCLUSIONS: In conclusion, the filtering operation significantly decreases IOP in juvenile glaucoma.