RESUMO
Glaucoma is a common and sight-threatening complication of pediatric cataract surgery Reported incidence varies due to variability in study designs and length of follow-up. Consistent and replicable risk factors for developing glaucoma following cataract surgery (GFCS) are early age at the time of surgery, microcornea, and additional surgical interventions. The exact mechanism for GFCS has yet to be completely elucidated. While medical therapy is the first line for treatment of GFCS, many eyes require surgical intervention, with various surgical modalities each posing a unique host of risks and benefits. Angle surgical techniques include goniotomy and trabeculotomy, with trabeculotomy demonstrating increased success over goniotomy as an initial procedure in pediatric eyes with GFCS given the success demonstrated throughout the literature in reducing IOP and number of IOP-lowering medications required post-operatively. The advent of microcatheter facilitated circumferential trabeculotomies lead to increased success compared to traditional <180° rigid probe trabeculotomy in GFCS. The advent of two-site rigid-probe trabeculotomy indicated that similar results could be attained without the use of the more expensive microcatheter system. Further studies of larger scale, with increased follow-up, and utilizing randomization would be beneficial in determining optimum surgical management of pediatric GFCS.
RESUMO
PURPOSE: Highlights the high-frequency deep sclerotomy as a competing ab interno surgery in open-angle glaucoma patients and evaluates the efficacy of high-frequency deep sclerotomy in lowering IOP of chronic open-angle glaucoma patients, in addition to the evaluation of the safety of the procedure on the corneal endothelium. DESIGN: A prospective study. It was performed in the Research Institute of Ophthalmology, Cairo. PARTICIPANTS: 43 eyes were enrolled for the study. All eyes were diagnosed with chronic open-angle glaucoma. METHODS: The procedure was performed using the abee® glaucoma tip of Oertli phacoemulsification machine (OS3, Switzerland) and goniolens performing nasal six pockets penetrating 1 mm deep into the trabecular meshwork and Schlemm's canal. Patients were followed up regarding vision and intraocular pressure (IOP) for 9 months. Endothelial cell count and coefficient of variation were calculated using specular microscopy preoperatively and 9 months postoperatively. RESULTS: The mean preoperative IOP was 31.4 ± 4.71 mmHg (range: 22 to 42 mmHg). All patients were followed up for nine months. The mean IOP was 19.06 ± 1.907 mmHg (range: 15 to 26 mmHg) by the end of the study. The reduction across the follow-ups was statistically significant (P < 0.0001). The percentage of total success was 90.7% (39 eyes). Four eyes (9.3%) had IOP > 21 (failed) after surgery and continued on antiglaucoma therapy. CONCLUSION: High-frequency deep sclerotomy is a safe and promising minimally invasive procedure which successfully achieves a lower IOP for chronic open-angle glaucoma patients, but not adequate for advanced glaucoma patients. This trial is registered with PACTR201910823824561.