Glaucoma Following Pediatric Cataract Surgery
Conditions
Keywords
GATT - GFCS
Brief summary
This prospective case series evaluated the 12-month outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in children with glaucoma following cataract surgery (GFCS). Glaucoma following pediatric cataract surgery is a recognized postoperative complication that may require surgical management when medical therapy is insufficient. Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive conjunctiva-sparing procedure designed to improve aqueous outflow through circumferential trabeculotomy. This prospective interventional case series will evaluate outcomes of GATT in eligible pediatric patients with glaucoma following cataract surgery treated at Cairo University Hospitals. Participants will undergo preoperative ophthalmic assessment, standardized surgical intervention, and scheduled postoperative follow-up visits. Outcomes to be assessed include intraocular pressure, use of glaucoma medications, and safety parameters during follow-up.
Detailed description
12-month Outcome of Gonioscopy-assisted Transluminal Trabeculotomy in Pediatric Glaucoma Following Cataract Surgery. Abstract Introduction Glaucoma following cataract surgery (GFCS) represents the most common vision-threatening complication after pediatric lensectomy, frequently necessitating surgical management. While ab-externo circumferential trabeculotomy has yielded promising results in previous studies, gonioscopy-assisted transluminal trabeculotomy (GATT) offers a minimally invasive, conjunctiva-sparing ab-interno approach for circumferential angle incision. This study evaluated the outcome of GATT in children diagnosed with GFCS. Methods This prospective interventional case series included 30 eyes of 24 pediatric patients (aged 0.5-13 years) diagnosed with GFCS. We excluded eyes with opaque corneas, extensive synechial angle closure, eyes in which \>180° incision could not be achieved and patients who could not complete a 12-month follow-up period. The primary outcomes were IOP reduction and changes in number of antiglaucoma medications; secondary outcomes were surgical success and complications. Success was defined as final IOP ≤21 mmHg without further glaucoma intervention and absence of vision-threatening complications.
Interventions
PROCEDUREgonioscopy assissted transluminal trabeculotomy
The operating microscope is tilted 45 degrees,, the head of the bed is elevated, and the head of the patient is tilted to the opposite side. While sitting on the temporal side of the patient a temporal corneal incision is created by a 23 Gauge MVR. An inferior or superior paracentesis is created. The anterior chamber (AC) is filled using cohesive viscoelastic then the angle is visualized by direct gonioscopy using Swan Jacob lens. Nasal goniotomy for 2 clock is performed by using MVR blade to incise the inner wall of Schlemm's canal. Cohesive OVD is used to open the lips of the incision, then 5/0 prolene after being blunted by cautery pen is threaded inside Schlemm's canal guided it inside the canal using 23-gauge vitreoretinal forceps until we retrieve it from the opposite end of the incision. The two ends of the 5/0 prolene suture are pulled to incise the Schlemm's canal and trabecular meshwork over 360°.The AC is washed by BSS followed by injection of air to tamponade any bleeding t
Sponsors
Cairo University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This was a single-group interventional study in which all enrolled eyes underwent gonioscopy-assisted transluminal trabeculotomy (GATT) without a comparison group.
Eligibility
Sex/Gender
ALL
Age
6 Months to 13 Years
Healthy volunteers
No
Inclusion criteria
* pediatric glaucoma following cataract surgery with clear cornea allowing visualization of the angle
Exclusion criteria
* opaque corneas, extensive synechial angle closure, eyes in which \>180° incision could not be achieved and patients who could not complete a 12-month follow-up period
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| IOP reduction | 12 month post operative | Change in intraocular pressure (IOP) from baseline to 12 months after gonioscopy-assisted transluminal trabeculotomy (GATT) in pediatric eyes with glaucoma following cataract surgery |
| Change in Number of Antiglaucoma Medications | 12 month postoperatively | Change in the number of antiglaucoma medications used from baseline to 12 months after GATT in pediatric eyes with glaucoma following cataract surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| surgical success | 12 month postoperatively | Success was defined as final IOP ≤21 mmHg without further glaucoma intervention and absence of vision-threatening complications. |
Countries
Egypt
Contacts
PRINCIPAL_INVESTIGATORMarwa E Soliman
Cairo University
Outcome results
None listed