Outcome of angle surgery in children with aphakic glaucoma

PURPOSE To investigate the outcome of trabeculotomy and/or goniotomy for pediatric aphakic glaucoma. METHODS Retrospective chart review of consecutive children who had congenital cataract surgery between 1990 and 2006 and required goniotomy and/or trabeculotomy for aphakic glaucoma. Treatment success was defined as postoperative intraocular pressure of <= 24 mm Hg despite topical medication use, avoidance of trabeculectomy or shunt placement, and no visually significant complications in the follow-up period. Exclusion criteria included a diagnosis of anterior segment dysgenesis, microcornea, and glaucoma at the time of cataract surgery, and follow-up less than 1 year. RESULTS A total of 14 eves of 11 patients met inclusion criteria, with a mean follow-up of 4.7 years. Of theses, 2 eyes had goniotomy alone, 3 eyes had goniotomy followed by trabeculotomy, and 9 eves had trabeculotomy alone. Mean TOP before angle surgery was 35 +/- 10 mm Hg. Mean TOP at the last recorded visit was 22 +/- 4 mm Hg (p = 0.0005). Treatment success was observed in 8 of the 14 eves (57.1%), with a mean number of angle procedures of 1.4 per eve: 6 eves (42.8%) were successful after a single angle surgery, each involving an initial trabeculotomy; 3 eves (21.4%) underwent subsequent shunt placement after initial goniotomy at 6 months, 1.3 years, and 5.5 years after the last angle surgery. CONCLUSIONS When intraocular surgery is indicated to control TOP in pediatric aphakic glaucoma, trabeculotomy and/or goniotomy can be successful in the majority of eyes and may decrease the need for filtering. and shunting procedures. (J AAPOS 2010;14:235-239)