gms | German Medical Science

The aim of this study is to assess the functional results and morphological parameters in children surgically treated for glaucoma.

Data from 30 patients and 49 eyes who were operated on in our department between 1995 and 2002 were collected. This retrospective trial included primary congenital glaucoma (n=25), and secondary glaucoma (n=5) in Rieger-Axenfeld syndrome and Sturge Weber syndrome. Overall the intraocular pressure (IOP), antero-posterior diameter of the eyeball, visual acuity, refractive errors and orthoptic status were analysed.

The age of patients at first surgery was 6.5 ± 5.7 months (range 0.7 to 28 months).The mean period of follow-up was 45.6 ± 22.9 months (8 - 90).The mean number of surgical procedures performed on one eye was 2.7 ± 2.6 procedures (1 - 11).The mean IOP before the first surgery was 31.8 ± 6.9 mmHg (17 - 51), and decreased at the last visit to 14 ± 2.3 mmHg (10 - 22). 43 eyes (87,8%) did not need any further medical treatment after the last surgical procedure. The IOP was under 17mmHg in 27 eyes (55,1%) after just one surgical procedure (19 eyes after trabeculotomy, 8 eyes after trabeculotomy and trabeculectomy with or without mitomycin-c). At the first examination, the mean antero-posterior diameter of the eyeball was 22.8 ± 1.6 mm (the normal value at this age is 20.2 ± 0.8 mm), and at the last visit it was 24.5 ± 2.2 mm (the normal value at this age is 22.5 ± 0.4 mm).The best corrected visual acuity at the last visit was 0.3 ± 4.5 lines (LogMar chart), the normal value at this age is from 0.4 ± 3.4 lines to 0,8 ± 2,3 lines. Visual acuity was 0.3 or more in 57,1% of the eyes. Only in 10,2% of the eyes it was inferior to 0,1. The main refractive error, myopia was present in 69.4% of the eyes, the amount of which corresponded to the spherical equivalent of -5.2 ± 4.5 dioptres. 8 patients (26.7 %) developed a misalignment, 13 patients (43,3%) were treated with part time occlusion. Binocular functions as assessed with the Lang 1-test was positive in 12 patients (40%).

Though a good long-term control of the intra-ocular pressure can often be achieved in childhood glaucoma, the visual acuity remains below the normal range in most children.