Clinical observation of microcatheter assisted trabeculotomy on the treatment of childhood glaucoma

Objective

To investigate the clinical efficacy and safety of microcatheter assisted trabeculectomy on the treatment of childhood glaucoma.

Methods

A prospective case series method was performed.Sixteen childhood glaucoma with 22 eyes were enrolled in Henan Eye Hospital and Zhengzhou Second People’s Hospital from December 2016 to August 2017.Nine males with 12 eyes and 7 females with 10 eyes were included, and the age ranged from 6 months to 8 years (median 4 years). All the subjects underwent microcatheter assisted trabeculectomy.The intraocular pressure changes were observed preoperation and 7 days, 1 month and 6 months after surgery, and the postoperative complications were analyzed.This study was approved by the Ethics Committee of Henan Eye Hospital (2018KS-01)and Zhengzhou Secord People’s Hospital (No.20161202001), and adhered to the tenets of the Declaration of Helsinki.Written informed consent was obtained from each guardia prior to any medical examination.

Results

Twenty eyes of 14 patients underwent microcatheter assisted trabeculectomy, the success rate was 90.91%.Twelve eyes were operated with full incision (incision range was 360°), 8 eyes were performed with subtotal incision (incision range was 180°-330°), while the microcatheter could not pass over 90° in 2 eyes and was switch to traditional Harms knife trabeculotomy-trabeculectomy intraoperatively.The intraocular pressures of the 20 eyes that underwent microcatheter assisted trabeculectomy preoperation, 7 days, 1 month and 6 months after surgery were (26.55±4.38), (20.48±3.62), (13.71±6.35) and (12.67±5.37)mmHg, respectively.The intraocular pressures in patients at different time points were statistically significant (F=112.771, P<0.001). At the last follow-up, the intraocular pressures of 18 eyes were controlled.Among them, 16 eyes achieved completely controlled intraocular pressure while 2 eyes returned to normal intraocular pressure after using ocular hypotensive drugs.The intraocular pressure of 2 eyes increased again after operation, and the intraocular pressure could not be controlled after combined use of anti-hypertensive drugs.All patients had no serious complications during and after the operation.Different degrees of anterior chamber hemorrhage occurred in 16 eyes during the surgery, and all the hemorrhages were absorbed within 1 week after surgery.

Conclusions

For children with glaucoma, microcatheter assisted trabeculectomy can achieve good intraocular pressure reduction effect without serious complications.