To evaluate surgical and visual outcomes of modified adjusted trabeculotomy in juvenile glaucoma (JG) cases. A retrospective case series; medical records of 43 patients (69 eyes) JG cases operated by… Click to show full abstract
To evaluate surgical and visual outcomes of modified adjusted trabeculotomy in juvenile glaucoma (JG) cases. A retrospective case series; medical records of 43 patients (69 eyes) JG cases operated by adjusted trabeculotomy between 2011 and 2018. Those who completed a minimum of 1 year of regular follow-up, and up to 5 years were included in the study. Intraocular pressure (IOP), number of medications, cup/disc ratio (CDR), and visual acuity (VA) at baseline, postoperative 1, 3, 5 years were evaluated. Success required IOP ≤ 18 mmHg and a minimum of 20% reduction, without medications (full), or with medications (qualified). Numbers of patients (eyes) who completed 1, 3, and 5 follow-up years were as follows: 26 (43), 15 (27), and 11 (19). Median (range) age at surgery was 21.5 (8–43) years. Mean (range) IOP was significantly (P < .001) reduced from 23.4 ± 8.8 (11.0–46.0) mmHg to 11.5 ± 3.5 (7.0–28.0), 10.9 ± 3.6 (6.0–24.0), and 11.4 ± 3.0 (7.0–17.0) mmHg at 1, 3, and 5 years, with reduction of medication scores. At years 1, 3, and 5, complete success rates were 89.5%, 86.8%, and 89.5%, and qualified success rates were 97.4%, 94.7%, and 97.4%. Median (range) LogMAR VA significantly (P < .001) improved from 0.3 (0–2.8) to 0.17 (0–2.8) and 0.17 (0–2.8) at 1 and 5 years. Median (range) CDR was significantly (P < .001) reduced from 0.85 (0.3–1.0) to 0.85 (0.1–1.0), 0.7 (0.05–1.0), and 0.7 (0.05–0.9) at 1, 3, and 5 years. Adjusted trabeculotomy could effect remarkable IOP lowering for up to 5 years postoperatively in JG eyes, and seems to be an effective, low-risk surgical modality for treating such eyes. It can be associated with cupping reversibility, and visual improvement on the long-term. Good surgical technique and postoperative care are imperative to achieve a successful outcome.
               
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