Global Pediatric Ophthalmology Congress

Biography

Biography: Ahmed Fahmi

Abstract

Background: The objective of this study was to evaluate the outcome of surgery and the factors affecting it in children with primary childhood glaucoma attending Makka Eye Complex in Riyadh, Khartoum in the period from January 2011 to June 2012. Methodology: This is a prospective, descriptive, hospital based study. A total of 32 patients were involved after confirming the diagnosis of PCG. Preoperative data including IOP, corneal diameter and clarity, CD ratio and refraction were considered. The eyes were classified as having mild, moderate or severe disease based on intraocular pressure, corneal diameter and corneal clarity. Main outcome measures were postoperative intraocular pressures, corneal diameter, corneal clarity, bleb characteristics, surgical success, and complications. Complete surgical success was defined as a postoperative intraocular pressure of ≤21 mm Hg without additional medical or surgical therapy, and with stabilization of corneal diameter and CD ratio. Success was considered qualified when anti-glaucoma drugs were needed to maintain these criteria. Failure was defined as IOP greater than 21 mmHg or the occurrence of sight-threatening complications, or the need for additional surgery. Results: A total of 60 eyes of 32 patients were included in the study. Twenty one (65.6%) of the patients was males. Mean age at presentation was 17.7±30.6 months (range 0.25-120 months). Mean duration of the disease was 14±24.7 months (range 0.25–96 months). Twenty nine infants (91%) had bilateral disease. Mean duration of follow-up was 9.48 ±3.7 months (range 6–21months). Surgeries performed were combined trabeulotomy-trabeculectomy, augmented trabeculectomy and goniotomy. Mean preoperative and postoperative IOP were 23.1 and 14.9 mmHg respectively, with a mean reduction of 8.2 mmHg (P-value 0.00). The mean preoperative horizontal corneal diameter was 12.7±1.2 mm. Corneal-oedema was present in 93.3% of eyes preoperatively. Postoperatively no oedema was found in 68% of eyes. Complete success was obtained in 60% of the study population and qualified success in 18%, while 22% of the study population was considered as failures. Six eyes required secondary surgical intervention and 22 were on antiglaucoma medication at the last follow-up. There were no major postoperative complications apart from phthisis bulbi which developed in one eye. Risk factors of surgical failure were early age of presentation, short duration of disease, severe disease and severe corneal oedema. Conclusion: The overall surgical success of primary congenital glaucoma was 78%. Age of presentation, duration of disease, severity and corneal clarity significantly affect the surgical outcome.