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Childhood Glaucoma Surgery in Developing Countries

  • Anil K. Mandal
  • Sirisha Senthil
Chapter

Abstract

Childhood glaucoma affects more than 300,000 children worldwide; two-thirds of these children are already blind, and three-fourths of them live in developing countries. The high prevalence rate of primary congenital glaucoma (PCG) in the developing world is due to higher parental consanguinity in some communities. There is also a high incidence of secondary glaucomas associated with aphakia and pseudophakia, post-trauma, and steroid use. Caring for children with glaucoma is challenging due to its wide variability in presentation and clinical course with various treatment options and response to treatment. Surgery is the mainstay of treatment for most childhood glaucomas, especially PCG, with early surgery leading to a better prognosis. However, in developing countries, children tend to present late with advanced disease at presentation, resulting in delayed diagnosis and surgery. Primary combined trabeculotomy-trabeculectomy is often the preferred technique in the developing world. Although it has good success rates initially, surgical failure increases with time and is higher in eyes with greater severity of disease at presentation. Many such children need multiple surgical procedures for intraocular pressure (IOP) control. When primary surgery fails, medical treatment is initiated with appropriate glaucoma medications. If medical treatment is ineffective, trabeculectomy with antiscarring agents or glaucoma drainage device (GDD) implantation is the next choice. In eyes with uncontrolled IOP and poor or nil visual potential or with severely scarred conjunctiva precluding a GDD procedure, transscleral cyclophotocoagulation is preferred. The management of these complex cases does not end with surgery; close follow-up and visual rehabilitation help to achieve substantial success.

Keywords

Primary congenital glaucoma Combined trabeculotomy and trabeculectomy Refractory pediatric glaucoma Developing countries Childhood glaucoma surgery Glaucoma drainage device surgery 

Supplementary material

Video 11.1

Surgical technique of combined trabeculotomy-trabeculectomy in a case of primary congenital glaucoma presenting with acute corneal hydrops. (Courtesy of Anil K. Mandal, MD, FAMS, L. V. Prasad Eye Institute, Hyderabad, India) (MPG 147496 kb)

Video 11.2

Step-by-step surgical technique for Aurolab aqueous drainage implant surgery . (Courtesy of Sirisha Senthil, MS, FRCS (Edin), L. V. Prasad Eye Institute, Hyderabad, India) (MOV 90142 kb)

Video 11.3

Step-by-step surgical technique for Ahmed glaucoma valve surgery . (Courtesy of Sirisha Senthil, MS, FRCS (Edin), L. V. Prasad Eye Institute, Hyderabad, India) (MOV 92554 kb)

References

  1. 1.
    Rahi JS, Gilbert CE. Epidemiology and the worldwide impact of visual impairment in children. In: Lambert SR, Lyons CJ, editors. Taylor and Hoyt’s pediatric ophthalmology and strabismus. 5th ed. Philadelphia: Elsevier; 2016. p. 7–16.Google Scholar
  2. 2.
    World Health Organization/International Agency for the Prevention of Blindness. Global initiative for the elimination of avoidable blindness. Geneva: WHO; 1998.Google Scholar
  3. 3.
    World Health Organization. Preventing blindness in children: report of a WHO/IAPB scientific meeting, Hyderabad, India, 13–17 April 1999, WHO/PBL/00.77.Google Scholar
  4. 4.
    Beck AD. Primary congenital glaucoma in the developing world. Ophthalmology. 2011;118(2):229–30.CrossRefGoogle Scholar
  5. 5.
    Hoguet A, Grajewski A, Hodapp E, Chang TC. A retrospective survey of childhood glaucoma prevalence according to Childhood Glaucoma Research Network classification. Indian J Ophthalmol. 2016;64(2):118–23.CrossRefGoogle Scholar
  6. 6.
    Papadopoulos M, Cable N, Rahji J, Khaw PT. The British infantile and childhood glaucoma (BIG) eye study. Invest Ophthalmol Vis Sci. 2007;48:4100–6.CrossRefGoogle Scholar
  7. 7.
    Gencik A, Gencikova A, Ferak V. Population genetical aspects of primary congenital glaucoma. I. Incidence, prevalence, gene frequency, and age of onset. Hum Genet. 1982;61(3):193–7.CrossRefGoogle Scholar
  8. 8.
    Gencik A. Epidemiology and genetics of primary congenital glaucoma in Slovakia. Description of a form of primary congenital glaucoma in gypsies with autosomal-recessive inheritance and complete penetrance. Dev Ophthalmol. 1989;16:76–115.PubMedGoogle Scholar
  9. 9.
    Bejjani BA, Lewis RA, Tomey KF, Anderson KL, Dueker DK, Jabak M, et al. Mutations in CYP1B1, the gene for cytochrome P4501B1, are the predominant cause of primary congenital glaucoma in Saudi Arabia. Am J Hum Genet. 1998;62(2):325–33.CrossRefGoogle Scholar
  10. 10.
    Dandona L, Williams JD, Williams BC, Rao GN. Population-based assessment of childhood blindness in southern India. Arch Ophthalmol. 1998;116(4):545–6.PubMedGoogle Scholar
  11. 11.
    Barkan O. Operation for congenital glaucoma. Am J Ophthalmol. 1942;25(5):552–68.CrossRefGoogle Scholar
  12. 12.
    deLuise VP, Anderson DR. Primary infantile glaucoma (congenital glaucoma). Surv Ophthalmol. 1983;28(1):1–19.CrossRefGoogle Scholar
  13. 13.
    Mandal AK. Current concepts in the diagnosis and management of developmental glaucomas. Indian J Ophthalmol. 1993;41(2):51–70.PubMedGoogle Scholar
  14. 14.
    Agarwal HC, Sood NN, Kalra BR. Clinical presentation of congenital glaucoma. Indian J Ophthalmol. 1983;31(5):619–22.PubMedGoogle Scholar
  15. 15.
    Harms H, Dannheim R. Epicritical consideration of 300 cases of trabeculotomy 'ab externo'. Trans Ophthalmol Soc UK. 1970;89:491–9.PubMedGoogle Scholar
  16. 16.
    Dannheim R. Symposium: microsurgery of the outflow channels. Trabeculotomy. Trans Am Acad Ophthalmol Otolaryngol. 1972;76(2):375–83.PubMedGoogle Scholar
  17. 17.
    McPherson SD Jr. Results of external trabeculotomy. Am J Ophthalmol. 1973;76(6):918–20.CrossRefGoogle Scholar
  18. 18.
    Luntz MH, Livingston DG. Trabeculotomy ab externo and trabeculectomy in congenital and adult-onset glaucoma. Am J Ophthalmol. 1977;83(2):174–9.CrossRefGoogle Scholar
  19. 19.
    Luntz MH. The advantages of trabeculotomy over goniotomy. J Pediatr Ophthalmol Strabismus. 1984;21(4):150–3.PubMedGoogle Scholar
  20. 20.
    Burian HM. A case of Marfan’s syndrome with bilateral glaucoma. With description of a new type of operation for developmental glaucoma (trabeculotomy ab externo). Am J Ophthalmol. 1960;50:1187–92.CrossRefGoogle Scholar
  21. 21.
    Allen L, Burian HM. Trabeculotomy ab externo. A new glaucoma operation: technique and results of experimental surgery. Am J Ophthalmol. 1962;53:19–26.CrossRefGoogle Scholar
  22. 22.
    Smith R. A new technique for opening the canal of Schlemm. Preliminary report. Br J Ophthalmol. 1960;44:370–3.CrossRefGoogle Scholar
  23. 23.
    Luntz MH. Congenital, infantile, and juvenile glaucoma. Ophthalmology. 1979;86(5):793–802.CrossRefGoogle Scholar
  24. 24.
    Kiffney GT Jr, Meyer GW, SD MP Jr. The surgical management of congenital glaucoma. South Med J. 1960;53:989–93.CrossRefGoogle Scholar
  25. 25.
    Beauchamp GR, Parks MM. Filtering surgery in children: barriers to success. Ophthalmology. 1979;86(1):170–80.CrossRefGoogle Scholar
  26. 26.
    Cadera W, Pachtman MA, Cantor LB, Ellis FD, Helveston EM. Filtering surgery in childhood glaucoma. Ophthalmic Surg. 1984;15(4):319–22.PubMedGoogle Scholar
  27. 27.
    Levene RZ. Glaucoma filtering surgery: factors that determine pressure control. Ophthalmic Surg. 1984;15(6):475–83.PubMedGoogle Scholar
  28. 28.
    Debnath SC, Teichmann KD, Salamah K. Trabeculectomy versus trabeculotomy in congenital glaucoma. Br J Ophthalmol. 1989;73(8):608–11.CrossRefGoogle Scholar
  29. 29.
    Rao KV, Sai CM, Babu BV. Trabeculectomy in congenital glaucoma. Indian J Ophthalmol. 1984;32(5):439–40.PubMedGoogle Scholar
  30. 30.
    Burke JP, Bowell R. Primary trabeculectomy in congenital glaucoma. Br J Ophthalmol. 1989;73(3):186–90.CrossRefGoogle Scholar
  31. 31.
    Miller MH, Rice NS. Trabeculectomy combined with beta irradiation for congenital glaucoma. Br J Ophthalmol. 1991;75(10):584–90.CrossRefGoogle Scholar
  32. 32.
    Fulcher T, Chan J, Lanigan B, Bowell R, O'Keefe M. Long-term follow up of primary trabeculectomy for infantile glaucoma. Br J Ophthalmol. 1996;80(6):499–502.CrossRefGoogle Scholar
  33. 33.
    Mandal AK, Walton DS, John T, Jayagandan A. Mitomycin C-augmented trabeculectomy in refractory congenital glaucoma. Ophthalmology. 1997;104(6):996–1001. discussion 2–3CrossRefGoogle Scholar
  34. 34.
    Mandal AK, Prasad K, Naduvilath TJ. Surgical results and complications of mitomycin C-augmented trabeculectomy in refractory developmental glaucoma. Ophthalmic Surg Lasers. 1999;30(6):473–80.PubMedGoogle Scholar
  35. 35.
    Sood NN, Aggarwal HC, Kalra BR. Evaluation of surgery for congenital glaucoma. Indian J Ophthalmol. 1983;31(5):609–11.PubMedGoogle Scholar
  36. 36.
    Elsayed TH, El-Raggal TM. Mitomycin-C needle bleb revision in congenital glaucoma. Middle East Afr J Ophthalmol. 2010;17(4):369–73.CrossRefGoogle Scholar
  37. 37.
    Christalkis PG, Zhang D, Budenz DL, Barton K, Tsai JC, Ahmed IIK, ABC-AVB Study Groups. Five-year pooled data analysis of the Ahmed Baerveldt comparison study and the Ahmed versus Baerveldt study. Am J Ophthalmol. 2017;176:118–26.CrossRefGoogle Scholar
  38. 38.
    Khan AO, Almobarak FA. Comparison of polypropylene and silicone Ahmed valve survival 2 years following implantation in the first 2 years of life. Br J Ophthalmol. 2009;93(6):791–4.CrossRefGoogle Scholar
  39. 39.
    Netland PA, Walton DS. Glaucoma drainage implants in pediatric patients. Ophthalmic Surg. 1993;24(11):723–9.PubMedGoogle Scholar
  40. 40.
    Kirwan JF, Shah P, Khaw PT. Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas. Ophthalmology. 2002;109(2):316–23.CrossRefGoogle Scholar
  41. 41.
    Bowman RJ, Dickerson M, Mwende J, Khaw PT. Outcomes of goniotomy for primary congenital glaucoma in East Africa. Ophthalmology. 2011;118(2):236–40.CrossRefGoogle Scholar
  42. 42.
    Al-Hazmi A, Awad A, Zwaan J, Al-Mesfer SA, Al-Jadaan I, Al-Mohammed A. Correlation between surgical success rate and severity of congenital glaucoma. Br J Ophthalmol. 2005;89(4):449–53.CrossRefGoogle Scholar
  43. 43.
    Ben-Zion I, Tomkins O, Moore DB, Helveston EM. Surgical results in the management of advanced primary congenital glaucoma in a rural pediatric population. Ophthalmology. 2011;118(2):231–235.e1.CrossRefGoogle Scholar
  44. 44.
    Essuman VA, Braimah IZ, Ndanu TA, Ntim-Amponsah CT. Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population. Eye. 2011;25(1):77–83.CrossRefGoogle Scholar
  45. 45.
    Elder MJ. Congenital glaucoma in the West Bank and Gaza Strip. Br J Ophthalmol. 1993;77(7):413–6.CrossRefGoogle Scholar
  46. 46.
    Elder MJ. Combined trabeculotomy-trabeculectomy compared with primary trabeculectomy for congenital glaucoma. Br J Ophthalmol. 1994;78(10):745–8.CrossRefGoogle Scholar
  47. 47.
    Mullaney PB, Selleck C, Al-Awad A, Al-Mesfer S, Zwaan J. Combined trabeculotomy and trabeculectomy as an initial procedure in uncomplicated congenital glaucoma. Arch Ophthalmol. 1999;117(4):457–60.CrossRefGoogle Scholar
  48. 48.
    Biedner BZ, Rothkoff L. Combined trabeculotomy-trabeculectomy compared with primary trabeculotomy for congenital glaucoma. J Pediatr Ophthalmol Strabismus. 1998;35(1):49–50.PubMedGoogle Scholar
  49. 49.
    Dietlein TS, Jacobi PC, Krieglstein GK. Prognosis of primary ab externo surgery for primary congenital glaucoma. Br J Ophthalmol. 1999;83(3):317–22.CrossRefGoogle Scholar
  50. 50.
    Lawrence SD, Netland PA. Trabeculectomy versus combined trabeculotomy-trabeculectomy in pediatric glaucoma. J Pediatr Ophthalmol Strabismus. 2012;49(6):359–65.CrossRefGoogle Scholar
  51. 51.
    Khalil DH, Abdelhakim MA. Primary trabeculotomy compared to combined trabeculectomy-trabeculotomy in congenital glaucoma: 3-year study. Acta Ophthalmol. 2016;94(7):e550–4.CrossRefGoogle Scholar
  52. 52.
    Mandal AK, Gothwal VK, Nutheti R. Surgical outcome of primary developmental glaucoma: a single surgeon’s long-term experience from a tertiary eye care centre in India. Eye. 2007;21(6):764–74.CrossRefGoogle Scholar
  53. 53.
    Shi Y, Wang H, Yin J, Li M, Zhang X, Xin C, et al. Microcatheter-assisted trabeculotomy versus rigid probe trabeculotomy in childhood glaucoma. Br J Ophthalmol. 2016;100(9):1257–62.CrossRefGoogle Scholar
  54. 54.
    Shakrawal J, Bali S, Sidhu T, Verma S, Sihota R, Dada T. Randomized trial on illuminated-microcatheter circumferential trabeculotomy versus conventional trabeculotomy in congenital glaucoma. Am J Ophthalmol. 2017;180:158–64.CrossRefGoogle Scholar
  55. 55.
    Temkar S, Gupta S, Sihota R, Sharma R, Angmo D, Pujari A, et al. Illuminated microcatheter circumferential trabeculotomy versus combined trabeculotomy-trabeculectomy for primary congenital glaucoma: a randomized controlled trial. Am J Ophthalmol. 2015;159(3):490–497.e2.CrossRefGoogle Scholar
  56. 56.
    Helmy H. Combined trabeculotomy-trabeculectomy versus Ahmed valve implantation for refractory primary congenital glaucoma in Egyptian patients: a long-term follow-up. Electron Physician. 2016;8(2):1884–91.CrossRefGoogle Scholar
  57. 57.
    Dave P, Senthil S, Choudhari N, Sekhar GC. Outcomes of Ahmed valve implant following a failed initial trabeculotomy and trabeculectomy in refractory primary congenital glaucoma. Middle East Afr J Ophthalmol. 2015;22(1):64–8.CrossRefGoogle Scholar
  58. 58.
    Al-Mobarak F, Khan AO. Two-year survival of Ahmed valve implantation in the first 2 years of life with and without intraoperative mitomycin-C. Ophthalmology. 2009;116(10):1862–5.CrossRefGoogle Scholar
  59. 59.
    Balekudaru S, Vadalkar J, George R, Vijaya L. The use of Ahmed glaucoma valve in the management of pediatric glaucoma. J AAPOS. 2014;18(4):351–6.CrossRefGoogle Scholar
  60. 60.
    Kaushik S, Kataria P, Raj S, Pandav SS, Ram J. Safety and efficacy of a low-cost glaucoma drainage device for refractory childhood glaucoma. Br J Ophthalmol. 2017;101(12):1623–7.CrossRefGoogle Scholar
  61. 61.
    Magnusson G, Abrahamsson M, Sjostrand J. Glaucoma following congenital cataract surgery: an 18-year longitudinal follow-up. Acta Ophthalmol Scand. 2000;78(1):65–70.CrossRefGoogle Scholar
  62. 62.
    Baden C, Shija F, Lewallen S, Courtright P, Hall A. Glaucoma after pediatric cataract surgery in a population with limited access to care. J AAPOS. 2013;17(2):158–62.CrossRefGoogle Scholar
  63. 63.
    Ashaye A, Ashaolu O, Komolafe O, Ajayi BG, Olawoye O, Olusanya B, et al. Prevalence and types of glaucoma among an indigenous African population in southwestern Nigeria. Invest Ophthalmol Vis Sci. 2013;54(12):7410–6.CrossRefGoogle Scholar
  64. 64.
    Swamy BN, Billson F, Martin F, Donaldson C, Hing S, Jamieson R, et al. Secondary glaucoma after paediatric cataract surgery. Br J Ophthalmol. 2007;91(12):1627–30.CrossRefGoogle Scholar
  65. 65.
    Mandal AK, Bagga H, Nutheti R, Gothwal VK, Nanda AK. Trabeculectomy with or without mitomycin-C for paediatric glaucoma in aphakia and pseudophakia following congenital cataract surgery. Eye. 2003;17(1):53–62.CrossRefGoogle Scholar
  66. 66.
    Panicker SG, Reddy AB, Mandal AK, Ahmed N, Nagarajaram HA, Hasnain SE, et al. Identification of novel mutations causing familial primary congenital glaucoma in Indian pedigrees. Invest Ophthalmol Vis Sci. 2002;43(5):1358–66.PubMedGoogle Scholar
  67. 67.
    Mandal AK, Matalia JH, Nutheti R, Krishnaiah S. Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14 mm or more. Eye. 2006;20(2):135–43.CrossRefGoogle Scholar
  68. 68.
    Dorairaj SK, Bandrakalli P, Shetty C, R V, Misquith D, Ritch R. Childhood blindness in a rural population of southern India: prevalence and etiology. Ophthalmic Epidemiol. 2008;15(3):176–82.CrossRefGoogle Scholar
  69. 69.
    Gilbert C, Foster A. Childhood blindness in the context of VISION 2020--the right to sight. Bull World Health Organ. 2001;79(3):227–32.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Zagora SL, Funnell CL, Martin FJ, Smith JE, Hing S, Billson FA, et al. Primary congenital glaucoma outcomes: lessons from 23 years of follow-up. Am J Ophthalmol. 2015;159(4):788–96.CrossRefGoogle Scholar
  71. 71.
    Fieβ A, Shah P, Sii F, Godfrey F, Abbott J, Bowman R, et al. Trabeculectomy or transscleral cyclophotocoagulation as initial treatment of secondary childhood glaucoma in Northern Tanzania. J Glaucoma. 2017;26(7):657–60.CrossRefGoogle Scholar
  72. 72.
    Fieβ A, Furahini G, Bowman R, Bauer J, Dithmar S, Philippin H. Outcomes of surgical interventions for primary childhood glaucoma in Northern Tanzania. Br J Ophthalmol. 2017;101(2):126–30.CrossRefGoogle Scholar
  73. 73.
    Freedman BL, Jones SK, Lin A, Stinnett SS, Muir KW. Vision-related quality of life in children with glaucoma. J AAPOS. 2014;18(1):95–8.CrossRefGoogle Scholar
  74. 74.
    Dahlmann-Noor A, Tailor V, Bunce C, Abou-Rayyah Y, Adams G, Brookes J, Khaw PT, Papadopoulos M. Quality of life and functional vision in children with glaucoma. Ophthalmology. 2017;124(7):1048–55.CrossRefGoogle Scholar
  75. 75.
    Dada T, Aggarwal A, Bali SJ, Wadhwani M, Tinwala S, Sagar R. Caregiver burden assessment in primary congenital glaucoma. Eur J Ophthalmol. 2013;23(3):324–8.CrossRefGoogle Scholar
  76. 76.
    Gothwal VK, Bharani S, Mandal AK. Quality of life of caregivers of children with congenital glaucoma: development and validation of a novel questionnaire (CarCGQoL). Bull World Health Organ. 2015;56(2):770–7.Google Scholar
  77. 77.
    Gothwal VK, Bharani S, Mandal AK. Impact of surgery on the quality of life of caregivers of children with congenital glaucoma. Ophthalmology. 2016;123(5):1161–2.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Glaucoma and Pediatric OphthalmologyL. V. Prasad Eye InstituteHyderabadIndia

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