Correlation of postoperative axial length growth and intraocular pressure in congenital glaucoma – a retrospective study in trabeculotomy and goniotomy

BACKGROUND: This paper investigates the correlation of postoperative intraocular pressure (IOP) with axial length growth in children who underwent either trabeculotomy (TO) or goniotomy (GO) as primary surgery for congenital glaucoma. METHODS: Thirty-seven eyes of 21 children with congenital glaucoma who underwent one or two TOs from 1992 to 1997 and 26 eyes of 16 children with congenital glaucoma who underwent one or more GOs from 1974 to 1993 were retrospectively analyzed. None of the eyes had undergone other surgery previously. Thirteen of the TOs were combined with a small trabeculectomy. IOP was measured by handheld applanation tonometry (Perkins). Axial length was measured by ultrasound. The data were analyzed for correlation of postoperative IOP reduction with postoperative axial length growth. RESULTS: Mean duration of follow-up was 27.3 months in the TO eyes and 37.1 months in the GO eyes. Mean pretreatment IOP before surgery was 28.4+/-6.9 mmHg in the TO eyes and 30.8+/-8.5 mmHg in the GO eyes. Mean IOP at the end of follow-up was 17.5+/-5.8 mmHg in the TO eyes and 17.4+/-10.2 mmHg in the GO eyes. Axial length growth was normalized (proportional or slowed down compared with the nomogram of axial length growth) in 31 of the 37 TO eyes and in 20 of the 26 GO eyes, and was increased in 6 of the TO eyes and 6 of the GO eyes at the end of follow-up. Regarding axial length growth, 6 of 37 TO eyes had increased axial length growth at the end of follow-up. Three of these eyes also did not fulfill the IOP success criterion; 2 of the 3 eyes with normalized IOP had only borderline increased axial length growth. Six of 26 GO eyes had increased axial length growth at the end of follow-up. Five of these eyes did not fulfill the IOP success criterion; 1 eye with normalized IOP had only borderline increased axial length growth. CONCLUSION: The data show remarkably good correlation of postoperative IOP with postoperative axial length growth. Axial length measurements can therefore help to ascertain halting or progression of congenital glaucoma and thus are considered an important parameter for congenital glaucoma follow-up.     

Eye growth in children with primary congenital glaucoma after trabeculectomy

PURPOSE: Evaluation of the influence of intraocular pressure (IOP) after trabeculectomy on the axial length and refraction of eyeballs in children with primary congenital glaucoma. MATERIAL AND METHODS: Thirty six eyes of 23 children at the age from 7 days to 6.5 years (mean 17.1 months), were examined. Measurements of corneal diameter, axial length, IOP and refraction were done before trabeculectomy and in the long-term follow-up (mean 7.9 years) after surgery. RESULTS: Horizontal corneal diameter didn't change and ranged from 10 to 15 mm, mean 13.22 mm. Mean value of axial length before trabeculectomy was 22.45 mm and 23.27 mm at last visit. The difference was statistically significant. The axis decreased in 3 eyes, was the same in 3 eyes. In the others the eye growth changed proportionally to the age of child. IOP values were statistically lower after surgery (mean 16 mmHg) than before treatment (mean 35.51 mmHg). There was no correlation between IOP and axial length of eyeballs (p = 0.69) and between IOP and refraction changes (p = 0.42) in the long-term follow-up. CONCLUSIONS: There is small influence of normalised IOP after trabeculectomy on size of eyeballs and refraction in children with primary congenital glaucoma. The development of eyeballs even buphthalmic is proportionally to the age.     

Central corneal thickness in congenital glaucoma

PURPOSE: The aim of this study was to compare central corneal thickness between eyes with congenital glaucoma and normal fellow eyes in unilateral glaucoma or less affected fellow eyes in bilateral glaucoma. METHODS: Eyes of consecutive phakic children with congenital glaucoma and previous glaucoma surgery were examined under chloral hydrate. Complete ophthalmologic examination, central corneal thickness (CCT), axial length, and corneal diameter measurements were performed. Patients were included in the study if presented with intraocular pressure (IOP) less than 21 mm Hg and no biomicroscopic signs of corneal edema. RESULTS: Nine patients were included in the study. The mean CCT in the more affected eye/glaucomatous eye was 522.3 +/- 65.2 microm and in the less affected eye/healthy eye was 579.7 +/- 44.5 microm. This difference was statistically significant (P = 0.0013). CONCLUSION: CCT was significantly thinner in glaucomatous eyes than in normal fellow eyes in phakic children with congenital glaucoma. This finding may be another confounding factor when measuring IOP in these patients.     

Corneal thickness in congenital glaucoma

PURPOSE: To compare central corneal thickness between eyes with congenital glaucoma and normal controls and to correlate this parameter with corneal diameter and axial length. METHODS: Eyes of consecutive children with congenital glaucoma with previous glaucoma surgery and eyes of children with inadequacy of lacrimal drainage system with age less than 3 years old were examined under inhalatory general anesthesia. Complete ophthalmologic examination, central corneal thickness, axial length, and corneal diameter measurements were performed. All patients presented with intraocular pressure (IOP) less than 21 mm Hg and no clinical sign of corneal edema. RESULTS: Fifty-five eyes of 55 patients (30 congenital glaucoma and 25 controls) were examined (mean age = 16.6 +/- 10.6 months; 20 female/ 35 males). There was no significant difference in age and gender between glaucoma patients and normal subjects. Mean IOP was higher in glaucomatous eyes (P = 0.02). Corneal diameter and axial length between glaucomatous eyes and controls were significantly different (P < 0.0001 for both). Central corneal thickness was significantly thinner in glaucomatous eyes (P = 0.01). There was a significant correlation between corneal diameter and central corneal thickness and also between central corneal thickness and axial length (r2 = 0.32 and r2 = 0.18, respectively; P < 0.0001 for both). CONCLUSION: Central corneal thickness was significantly thinner in children with congenital glaucoma. This finding may be another confounding factor when measuring IOP in those patients. Pachymetry should be considered during their examination.     

Subluxatio lentis und Glaukom-Indikationen und Risiken Kataraktchirurgie

BACKGROUND: Iridodonesis is the clinical sign of lens subluxation. Acute glaucoma caused by a ciliolenticular block may develop. YAG iridotomy or peripheral iridectomy are rarely effective in controlling intraocular pressure. The results of phacoemulsification and posterior lens implantation for subluxated lens and glaucoma are reported. PATIENTS AND METHODS: Seven patients aged 69+/-9.5 years were followed up. All 10 eyes with subluxated lens and glaucoma had phacoemulsification and posterior chamber lens implantation. Two different groups relating to axial length could be analyzed. Intraoperative findings and postoperative glaucoma situation are reported. RESULTS: Six eyes had average axial length of 21.5+/-0.17 mm and previous acute glaucoma. Five of these eyes had therapeutic YAG iridotomy and one, peripheral iridectomy. All eyes had dysregulated glaucoma despite antiglaucomatous medications. After cataract surgery five of six eyes had regular intraocular pressure without any medication. Four eyes had average axial length of 24. 4+/-1.1 mm and chronic glaucoma. After complicated phacoemulsification three of these eyes had regular intraocular pressure with antiglaucomatous medication, one eye without. CONCLUSIONS: For short eyes with subluxated lens and preceding acute glaucoma, cataract surgery with posterior chamber lens implantation is an effective therapeutic procedure for IOP regulation. For chronic glaucoma with subluxated lens, conventional or surgical approach to glaucoma remains dominant.     

Management of uncontrolled glaucoma with the Molteno system

In glaucomatous eyes refractory to medication, laser techniques and conventional drainage surgery, intraocular pressure is often high, and visual loss rapid. In this situation a reliable, robust artificial outflow system is required. Molteno has evolved a plastic tube and plate device combined with a fibrosis suppression medication regimen. Thirty-eight eyes of 32 patients with uncontrolled glaucoma were treated with the Molteno system. Six months after operation mean intraocular pressure had been reduced from 41.0 +/- 13.6 to 16.2 +/- 5.6 mmHg. Eighteen eyes had pressures of 20 mmHg or less on no hypotensive therapy, 17 on reduced treatment. Three eyes had a pressure of 21 to 35 mmHg on treatment at six months. The 13 aphakic eyes responded as well as 25 phakic eyes. Five eyes with rubeotic glaucoma demonstrated pressures of less than 20 mmHg without therapy, four eyes with traumatic glaucoma required continuing medication with three having pressures below 22 mmHg. Of the seven eyes with uveitic glaucoma, one was lost, two required maintenance therapy; five of six surviving eyes had pressures below 20 mmHg. Fifteen eyes with congenital or juvenile glaucoma achieved pressures below 20 mmHg, three of these with timolol drops, three with timolol and acetazolamide, and nine with no treatment. While seven of seven eyes with refractory primary open-angle glaucoma attained pressures below 20 mmHg, all seven needed continuing mild hypotensive therapy. Eleven eyes underwent a one-stage procedure, while 27 eyes required a two-stage operation. Twenty-eight eyes received fibrosis suppression medication after the second stage, and 24 maintained or improved their preoperative visual acuity. Results have been encouraging: in general the Molteno system is recommended as the second drainage operation in all glaucomatous eyes in which conventional therapy has failed, and as the primary surgical procedure (after laser techniques) in eyes with rubeotic and uveitic glaucoma. Ciliary body destructive procedures should be restricted to control of symptoms in blind eyes.     

Success of trabeculotomy in patients with congenital glaucoma operated on within 3 months of birth

AIMS: To determine the efficacy and safety of trabeculotomy in congenital glaucoma patients operated on within first 3 months of birth. METHODS: A total of 36 eyes of 24 patients with congenital glaucoma, who underwent primary trabeculotomy within first 3 months of birth were included. Preoperative and postoperative intraocular pressures (IOP), corneal clarity, diameter, axial length, success rates, and complications were evaluated in this study. RESULTS: The mean follow-up was 38.38+/-11.77 months (range 12-48 months). Mean IOP was 33.16+/-7.28 mmHg (range 23-50 mmHg) preoperatively. At the final follow-up visit, the mean IOP was 21.41+/-7.34 mmHg (range 8-38 mmHg). Pre-and postoperative IOP differences were statistically significant at all examination periods (P<0.001). A12-, 24-, and 36-month success rates were 92, 82, and 74%, respectively. Survival analysis regarding to gender, preoperative corneal diameter and consaguinity were not statistically significant. Only preoperative axial length was a statistically significant parameter (P=0.024) for success. Postoperatively normal corneal clarity was achieved in 29 eyes (80.5%). The main complications were shallow anterior chamber in one (4.2%) eye and detachment of Descement's membrane in two (8.4%) eyes. CONCLUSIONS: Primary trabeculotomy is a safe and effective procedure for congenital glaucoma patients when operated within 3 months of birth. It has a favourable IOP control and a low rate of complications in three year period.     

Molteno implants in children

We report our experience with Molteno implants in 27 eyes of 20 children with glaucoma. Associated ocular findings included Sturge Weber syndrome (one patient), aniridia and retinoschisis (one patient), aphakia (seven patients, eight eyes), rubella syndrome (two patients), Peters anomaly (one patient), and Treacher Collins syndrome (one patient). Fifteen eyes received a single-plate implant, and 12 eyes received a double-plate implant in two stages. The patients' ages ranged from 2 months to 13 years (mean 47 +/- 55 months). The average number of previous glaucoma procedures was four per eye (range two to 10). The follow-up period ranged from 6 to 36 months (mean 20 +/- 9 months). The mean intraocular pressure before surgery was 34 +/- 4 mm Hg. The mean postoperative intraocular pressure was 19 +/- 11 mm Hg at 1 month and 19 +/- 6 mm Hg at 1 year (p < 0.001 at both times). After surgery nine eyes (33.3%) required no medication for control of intraocular pressure. Additional surgery was required in 12 eyes (44.4%). We believe the Molteno implant is a useful approach for children with glaucoma who fail to respond to standard medical and surgical treatments.     

New Management of Angle—closure Glaucoma by Phacoemulsification with Foldable Posterior Chamber Intraocular Lens Implantation

Objective: To investigate the management oi angle-closure glaucoma byphacoemulsification with foldable posterior chamber intraocular lens (PC-IOL)implantation.Design: Retrospective, noncontrolled interventional case series.Participants: In 36 eyes with angle-closure glaucoma (ACG) , there were 18 eyes withprimary acute angle-closure glaucoma (PACG) , 14 eyes with primary chronicangle-closure glaucoma (PCCG) , 3 eyes with secondary acute angle-closure glaucoma(SACG) and 1 eye with secondary chronic angle-closure glaucoma (SCCG).Intervention: Phacoemulsification with posterior chamber intraocular lens implantation.Main Outcome Measures: Postoperative visual acuity, IOP, axial anterior chamberdepth.Results: After a mean postoperative follow-up time of 8. 81±7. 45 months, intraocularpressure was reduced from a preoperative mean of 23. 81 ±17. 84 mmHg to apostoperative mean of 12. 54 4. 73 mmHg ( P =0. 001). Mean anterior chamber depthwas 1. 75 ± 0. 48 mm preoperatively and 2. 29 ?0. 38 mm postoperatively     

Retrospective evaluation of ocular axial length after unilateral cataract surgery with intraocular lens implantation in children and adolescents

PURPOSE: To evaluate the postoperative ocular axial length in children, who had unilateral cataract extraction with intraocular lens implantation. MATERIAL AND METHODS: In this retrospective study we studied 20 children (12 boys and 8 girls) in age from 7 to 20 years (mean 14 +/- 3.65 years), who had undergone surgery for unilateral cataract: 8 children had congenital cataract; 7 patients had traumatic cataract; in 5 cases there were secondary cataract: 3 children had cataract after uveitis, in 1 child cataract was due to steroid therapy because of nephrotic syndrome and 1 patient had neurodermatic cataract. In 16 cases PMMA lens was used, heparinized lens was implanted in 3 eyes and acrylic lens in 1 eye. The power of implants was from + 19 D to +24 D (mean 20.98 +/- 1.6 D). All measurements of axial length were obtained using ultrasound A scan. Examination was done from 14 months to 7.5 years after surgery (mean 3.5 +/- 1.55 years). The axial length in the operated eyes was compared with axial length of the fellow nonoperated eyes. RESULTS: Mean axial length in operated eyes was 22.58 +/- 1.56 mm. Mean axial length in fellow eyes was 22.96 +/- 1.42 mm. There were no significant differences between operated and nonoperated eyes (p>0.05). CONCLUSIONS: Cataract extraction with intraocular lens implantation does not influence rate of axial growth in children and adolescents.     

Serial axial length measurements in congenital glaucoma

PURPOSE: To illustrate the utility of axial length measurements in the management of congenital glaucoma. METHODS: Interventional case series. Twelve eyes of six consecutive patients with congenital glaucoma were followed with serial axial length measurements. The axial growth patterns were compared with the normal growth curve. RESULTS: Eight (66.7%) of 12 eyes had initial axial lengths longer than the normal range, and 4 eyes (33.3%) were within the normal range. After surgical intervention with good intraocular pressure control in 10 eyes, 3 eyes showed a decrease of axial length and 7 eyes showed no decrease of axial length, but the axial growth pattern paralleled the normal growth curve. After surgical intervention with poor intraocular pressure control, 2 eyes had axial growth pattern greater than the normal pattern. CONCLUSION: With intraocular pressure control in congenital glaucoma, axial length may decrease or the axial growth pattern may parallel the normal growth curve. Axial length measurements may be useful to monitor the control of congenital glaucoma.     

INTRAOCULAR PRESSURE DECREASE IN SURGICAL TREATMENT FOR CONGENI-TAL GLAUCOMA

INTRAOCULAR PRESSURE DECREASE IN SURGICAL TREATMENT FOR CONGENI-TAL GLAUCOMA@A.Lauretti$Sao Paulo University, Brazil @L.Silva Costa$Sao Paulo University, Brazil @C.Lau-retti$Sao Paulo University, Brazil     

Aqueous misdirection after glaucoma drainage device implantation.

OBJECTIVE: To describe the clinical presentation, outcome, and possible underlying mechanism of aqueous misdirection after glaucoma drainage device implantation. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Ten eyes (five primary open-angle glaucoma, four chronic angle-closure glaucoma, one nanophthalmos) of nine patients with a mean age of 68.5+/-12.0 years (range, 43-83 years). INTERVENTION: The authors reviewed the medical records of all patients with a clinical diagnosis of aqueous misdirection after Baerveldt glaucoma drainage device implantation at two tertiary care referral centers from October 1992 to October 1997. Surgery was performed in a standardized fashion; all drainage tubes were inserted in the anterior chamber and occluded with an external 7-0 polyglactin ligature. All eyes were treated with topical corticosteroids, cycloplegia, and aqueous suppressants. Eyes with persistent aqueous misdirection received neodymium:YAG (Nd:YAG) hyaloidotomy or pars plana vitrectomy. MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure, biomicroscopic anterior chamber depth, and antiglaucomatous medication. RESULTS: All eyes had axial shallowing of the anterior chamber, one or more patent iridotomies, and no ophthalmoscopic or B-scan ultrasonographic evidence of serous or hemorrhagic ciliochoroidal detachment. Median time to the development of angle-closure glaucoma was 33.5 days (range, 1-343 days) and mean intraocular pressure at diagnosis was 27.7+/-18.7 mm Hg (range, 10-62 mm Hg). Normalization of anterior segment anatomy was achieved with aqueous suppression and cycloplegia (one eye); Nd:YAG capsulotomy (four eyes); pars plana vitrectomy alone (two eyes) or with lensectomy (one eye), and pars plana vitrectomy with intraocular lens explanation (two eyes). Mean final intraocular pressure was 14.1+/-6.0 mmHg at a mean follow-up of 9.1+/-7.8 months after the development of aqueous misdirection (range, 1-23 months). CONCLUSIONS: Aqueous misdirection may develop days to months after glaucoma drainage device implantation. In this series, there was a poor response to medical therapy, and normalization in anterior chamber depth required aggressive laser and surgical therapy.     

Argon laser trabeculoplasty in younger patients with primary open-angle glaucoma

We conducted a retrospective comparison of the effectiveness of argon laser trabeculoplasty in controlling increased intraocular pressure in two different age groups treated for medically uncontrolled primary open-angle glaucoma. Of 15 eyes of patients less than 40 years old who had primary open-angle glaucoma, nine (60%) had uncontrolled intraocular pressures postoperatively and needed filtering surgery within two years of argon laser trabeculoplasty. Only two of 29 (7%) eyes in older patients had unacceptably high intraocular pressures during a mean (+/- 1 S.D.) follow-up period of 17 +/- 5 months. Older eyes had greater decreases in intraocular pressure (12 +/- 6 mm Hg) than younger eyes (5 +/- 6 mm Hg) after laser treatment. Failure in young eyes appeared to correlate with a high preoperative intraocular pressure. Thus, argon laser trabeculoplasty is not a reliably effective form of therapy for younger patients with primary open-angle glaucoma.     

Sequential or simultaneous cyclophotocoagulation and glaucoma drainage implant for refractory glaucoma

PURPOSE: To describe the outcomes of combining cyclophotocoagulation and tube-shunt glaucoma drainage implants, either sequentially or simultaneously, for the control of refractory glaucomas. PATIENTS AND METHODS: A retrospective review was conducted of all patients that had been treated at our institute with both cyclophotocoagulation and a tube-shunt glaucoma drainage implant in the same eye between January 1996 and June 2000. Preoperative and postoperative intraocular pressure, number of glaucoma medications, vision, and complications data were collected for each eye. RESULTS: A total of 10 eyes of 9 patients met the study criteria. The minimum follow-up period after the last surgery was 15 months. Intraocular pressures were reduced from 28.5 +/- 7.2 mm Hg preoperatively to 13.9 +/- 5.4 mm Hg postoperatively at 15 months (P < 0.000, n = 9). Medications were reduced from 2.7 +/- 1.2 preoperatively to 0.3 +/- 0.5 postoperatively at 15 months (P < 0.000, n = 9). Of the eight eyes with measurable Snellen acuity, postoperative vision decreased two or more lines in five eyes (63%). Complications included transient hypotony (one eye), transient serous choroidal detachment (two eyes), cystoid macular edema (two eyes), corneal edema (three eyes), and panuveitis with chronic hypotony and traction retinal detachment (one eye). CONCLUSIONS: Combining cyclophotocoagulation with tube-shunt glaucoma drainage implants can effectively reduce intraocular pressure and number of glaucoma medications needed to achieve target intraocular pressure goals. Further study is needed to determine the safety of this combined approach compared with other available options to manage refractory glaucomas.     

MANAGEMENT OF UNCONTROLLED GLAUCOMA WITH THE MOLTENO SYSTEM

In glaucomatous eyes refractory to medication, laser techniques and conventional drainage surgery, intraocular pressure is often high, and visual loss rapid. In this situation a reliable, robust artificial outflow system is required. Molteno has evolved a plastic tube and plate device combined with a fibrosis suppression medication regimen. Thirty-eight eyes of 32 patients with uncontrolled glaucoma were treated with the Molteno system. Six months after operation mean intraocular pressure had been reduced from 41.0 ± 13.6 to 16.2 ± 5.6 mmHg. Eighteen eyes had pressures of 20 mmHg or less on no hypotensive therapy, 17 on reduced treatment. Three eyes had a pressure of 21 to 35 mmHg on treatment at six months. The 13 aphakic eyes responded as well as 25 phakic eyes. Five eyes with rubeotic glaucoma demonstrated pressures of less than 20 mmHg without therapy, four eyes with traumatic glaucoma required continuing medication with three having pressures below 22 mmHg. Of the seven eyes with uveitic glaucoma, one was lost, two required maintenance therapy; five of six surviving eyes had pressures below 20 mmHg. Fifteen eyes with congenital or juvenile glaucoma achieved pressures below 20 mmHg, three of these with timolol drops, three with timolol and acetazolamide, and nine with no treatment. While seven of seven eyes with refractory primary open-angle glaucoma attained pressures below 20 mmHg. all seven needed continuing mild hypotensive therapy. Eleven eyes underwent a one-stage procedure, while 27 eyes required a two-stage operation. Twenty-eight eyes received fibrosis suppression medication after the second stage, and 24 maintained or improved their preoperative visual acuity. Results have been encouraging: in general the Molteno system is recommended as the second drainage operation in all glaucomatous eyes in which conventional therapy has failed, and as the primary surgical procedure (after laser techniques) in eyes with rubeotic and uveitic glaucoma. Ciliary body destructive procedures should be restricted to control of symptoms in blind eyes.     

A comparison of the intraocular pressure-lowering effect and safety of viscocanalostomy and trabeculectomy with mitomycin C in bilateral open-angle glaucoma

PURPOSE: To compare the intraocular pressure-lowering effect and safety of viscocanalostomy and trabeculectomy with mitomycin C. METHODS: Twenty-five patients with bilateral primary open-angle glaucoma were enrolled in a prospective clinical study. The eyes of each patient were randomly assigned to receive viscocanalostomy in one eye and trabeculectomy with mitomycin C in the other eye. The patients were followed up for 12 months. At each visit, best-corrected visual acuity, intraocular pressure, and the appearance of the surgical wound, anterior chamber, and indirect ophthalmoscopy were recorded. RESULTS: The mean baseline intraocular pressure was 25.0+/-2.2 mmHg in viscocanalostomy-treated eyes and 24.8+/-2.6 mmHg in trabeculectomy-treated eyes. The mean postoperative intraocular pressure was 15.3+/-1.7 mmHg, 17.1+/-1.5 mmHg, and 17.1+/-1.5 mmHg in viscocanalostomy-treated eyes and 11.7+/-4.4 mmHg, 11.8+/-4.6 mmHg, and 12.6+/-4.3 mmHg in trabeculectomy-treated eyes at 3-, 6- and 12-month intervals, respectively. The mean intraocular pressure in viscocanalostomy-treated eyes was significantly higher than that in trabeculectomy-treated eyes at every visit (P<0.0001). At 12 months, 16 viscocanalostomy-treated eyes (64%) and 22 trabeculectomy-treated eyes (88%) achieved an intraocular pressure of less than or equal to 20 mmHg without medication; there was a significant difference between the two groups (P=0.0240). There were fewer complications in viscocanalostomy-treated eyes. Complications included four cases of shallow anterior chamber (16%) and five of hypotony (20%) in trabeculectomy-treated eyes, against intraoperative microperforation of Descemet's membrane in one of viscocanalostomy-treated eye (4%). CONCLUSION: Trabeculectomy with mitomycin C may be more effective than viscocanalostomy in lowering intraocular pressure in patients with primary open-angle glaucoma, while eyes undergoing viscocanalostomy experience a lower incidence of complications. Further investigation of more cases is needed.     

Retrospective analysis of the risk factors for developing phacomorphic glaucoma

Aim:

To determine the risk factors for developing phacomorphic glaucoma in eyes with mature cataracts.

Materials and Methods:

This is a case-control study comprising of 90 eyes with phacomorphic glaucoma and 90 age- and sex-matched control eyes with mature cataracts without phacomorphic glaucoma. Patients with pre-existing glaucoma, previous intraocular surgery and /or absence of documented axial lengths were excluded from this study. Binary logistic regression analysis of the variables, axial length and anterior chamber depth, was performed. Anterior chamber depth of the contralateral eye was used as a proxy measure of the pre-phacomorphic state in the eye with phacomorphic glaucoma as majority of them first presented to our center during the phacomorphic attack without prior measurements of the pre-phacomorphic ACD or lens thickness; therefore, their anterior chamber depth would not be representative of their pre-phacomorphic state. Axial length of 23.7 mm was selected as a cut-off for dichotomized logistic regression based on the local population mean from published demographic data.

Results:

The mean age was 73.1 ± 10.2 years. All phacomorphic and control eyes were ethnic Chinese. The mean presenting intraocular pressures were 49.5 ± 11.8 mmHg and 16.7 ± 1.7 mmHg in the phacomorphic and control eyes respectively (P< 0.0001), whilst the median Snellen best corrected visual acuity were light perception and hand movement in the phacomorphic and control eyes respectively. Eyes with phacomorphic glaucoma had shorter axial length of 23.1 ± 0.9 mm median when compared with that of control eyes, 23.7 ± 1.5 mm (P = 0.0006). Eyes with AL ≤ 23.7 mm were 4.3 times as likely to develop phacomorphic glaucoma when compared with AL > 23.7 mm (P = 0.003).

Conclusion:

Axial length less than ≤ 23.7 mm was a risk factor for developing phacomorphic glaucoma. Eyes with AL shorter than the population mean were 4.3 times as likely to develop phacomorphic glaucoma compared with eyes with longer than average AL. In an area where phacomorphic glaucoma is prevalent and medical resources are limited, patients with AL shorter than their population mean may be considered for earlier elective cataract extraction as a preventive measure.     

先天性白内障儿童眼球发育的观察

目的通过观察眼轴和角膜屈光力,了解先天性白内障儿童的眼球发育状况.方法将64例单眼先天性白内障和107例双眼先天性白内障患儿分为1岁以下、1～3岁、4～5岁、6～9岁、10岁以上5个年龄组比较分析其眼轴和角膜屈光力情况.结果在P＝0.05水平上只有1～3岁组单眼先天性白内障患眼眼轴较健眼有显著性差异;单眼先天性白内障与双眼先天性白内障患眼轴长度无显著性差异;64.4%先天性白内障眼眼轴长于正常同龄儿童均值;单眼先天性白内障患儿的患眼与健眼间角膜屈光力无显著性差异.结论形觉剥夺只是影响先天性白内障眼轴发育的诸多因素之一,为儿童先天性白内障选择人工晶状体屈光度时也应考虑其他因素对眼轴发育的影响.     

Trabekulotomie bei kongenitalem Glaukom Ein Vergleich zur Goniotomie

PURPOSE: To compare the efficacy of trabeculotomy (TO) and that of goniotomy (GO) as a primary surgical procedure in congenital glaucoma. PATIENTS AND METHODS: We retrospectively analyzed 39 eyes of 22 children with congenital glaucoma who underwent TO with or without a small trabeculectomy. The results were compared to data on 34 eyes of 21 children who underwent GO for congenital glaucoma. RESULTS: The mean preoperative intraocular pressure (IOP) was 28.2 +/- 6.7 mmHg in TO eyes and 31.0 +/- 7.9 mmHg in GO eyes. Mean IOP at the end of follow-up was 17.7 +/- 6.0 mmHg in TO eyes and 18.9 +/- 9.1 mmHg in GO eyes. In 31 of 39 TO eyes (79.5%) and in 26 of 34 (76.5%) GO eyes the IOP was 21 mmHg or lower at the end of follow-up. Combining the criteria of an IOP greater than 21 and an IOP drop of at least 20%, the success rate was 71.8% (28/39) in TO eyes and 70.6% (24/34) in GO eyes. CONCLUSION: In this study the value of TO in controlling IOP was comparable to that of GO.