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. 2015 Jan 30:1:CD008213.
doi: 10.1002/14651858.CD008213.pub2.

Surgical interventions for primary congenital glaucoma

Deepta Ghate  1 , Xue Wang
Affiliations

Surgical interventions for primary congenital glaucoma

Deepta Ghate et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Primary congenital glaucoma (PCG) manifests within the first few years of a child's life and is not associated with any other systemic or ocular abnormalities. PCG results in considerable morbidity even in developed countries. Several surgical techniques for treating this condition, and lowering the intraocular pressure (IOP) associated with it, have been described.

Objectives: To compare the effectiveness and safety of different surgical techniques for PCG.

Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2014, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2014), EMBASE (January 1980 to June 2014), (January 1982 to June 2014), PubMed (January 1946 to June 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 23 June 2014.

Selection criteria: We included all randomized and quasi-randomized trials in which different types of surgical interventions were compared in children under five years of age with PCG.

Data collection and analysis: We used standard methodological procedures specified by The Cochrane Collaboration.

Main results: We included a total of six trials (four randomized and two quasi-randomized) with 102 eyes in 61 children. Two trials were conducted in the USA and one trial each in Egypt, Israel, Lebanon and Saudi Arabia. All trials included children aged younger than one year when diagnosed with PCG, and followed them for periods ranging from six months to five years.No two trials compared the same pair of surgical interventions, so we did not perform any meta-analysis. One trial compared trabeculotomy versus goniotomy; a second trial compared combined trabeculectomy-trabeculotomy with mitomycin C versus trabeculectomy-trabeculotomy with mitomycin C and deep sclerectomy; a third trial compared combined trabeculotomy-trabeculectomy versus trabeculotomy; a fourth trial compared one goniotomy versus two goniotomies; a fifth trial compared trabeculotomy versus viscocanalostomy; and the sixth trial compared surgical goniotomy versus neodymium-YAG laser goniotomy. For IOP change and surgical success (defined by IOP achieved), none of the trials reported a difference between pairs of surgical techniques. However, due to the limited sample sizes for all trials (average of 10 children per trial), the evidence as to whether a particular surgical technique is effective and which surgical technique is better still remains uncertain. Adverse events, such as choroidal detachment, shallow anterior chamber and hyphema, were reported from four trials. None of the trials reported quality of life or economic data.These trials were neither designed nor reported well overall. Two trials were quasi-randomized trials and judged to have high risk of selection bias; four trials were at unclear or high risk for performance bias and detection bias; and we judged one trial to have high risk of attrition bias due to high proportions of losses to follow-up. Due to poor study design and reporting, the reliability and applicability of evidence remain unclear.

Authors' conclusions: No conclusions could be drawn from the trials included in this review due to paucity of data. More research is needed to determine which of the many surgeries performed for PCG are effective.

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Figures

Figure 1
Figure 1
Results from searching for studies for inclusion in the review Included studies
Figure 2
Figure 2
Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

References

References to studies included in this review

    1. Anderson DR. Discussion of paper by Quigley HA. Ophthalmology. 1982;89(3):225–226.
    1. Bayoumi NH. Deep sclerectomy in pediatric glaucoma filtering surgery. Eye. 2012;26(12):1548–1553. - PMC - PubMed
    1. Biedner BZ, Rothkoff L. Combined trabeculotomy-trabeculectomy compared with primary trabeculotomy for congenital glaucoma. Journal of Pediatric Ophthalmology and Strabismus. 1998;35(1):49–50. - PubMed
    1. Catalano RA, King RA, Calhoun JH, Sargent RA. One versus two simultaneous goniotomies as the initial surgical procedure for primary infantile glaucoma. Journal of Pediatric Ophthalmology and Strabismus. 1989;26(1):9–13. - PubMed
    1. Noureddin BN, El-Haibi CP, Cheikha A, Bashshur ZF. Viscocanalostomy versus trabeculotomy ab externo in primary congenital glaucoma: 1-year follow-up of a prospective controlled pilot study. British Journal of Ophthalmology. 2006;90(10):1281–1285. - PMC - PubMed

References to studies excluded from this review

    1. Agarwal HC, Sood NN, Sihota R, Sanga L, Honavar SG. Mitomycin-C in congenital glaucoma. Ophthalmic Surgery and Lasers. 1997;28(12):979–985. - PubMed
    1. Asseman R, Corbel M, Leser C. Comparative results of trabeculotomy and goniotomy in buphthalmos [Resultats compares de la trabeculotomie et de la goniotomie chez le buphtalme] Bulletin des Societes d’Ophtalmologie de France. 1972;72(2):241–244. - PubMed
    1. Bohnke M, Sayar RB. Clinical results following cyclo-cryocoagulation with a nitrogen cooled probe [Klinische ergebnisse nach zyklokryokoagulation mit einer stickstoffgekuhlten sonde] Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 1990;87(2):134–137. - PubMed
    1. Colev G, Calin A, Ciglinian R. Trabeculectomy and trabeculotomy in the treatment of infantile glaucoma [Trabeculectomia si trabeculotomia in tratamentul glaucomului infantil] Revista de Chirurgie, Oncologie, Radiologie, O. R. L., Oftalmologie, Stomatologie, Oftalmologie. 1977;21(2):139–141. - PubMed
    1. Dascotte JC, Asseman R, Huron JC, Houliez T. Long-term results of the treatment of glaucoma in children [Resultats a long terme du traitement chirurgical du glaucome infantile] Bulletin des Societes d’Ophtalmologie de France. 1989;89(11):1269–1271. - PubMed

References to ongoing studies

    1. NCT01460017. Comparison between the outcome of deep sclerectomy and traditional trabeculotomy and trabeculectomy surgeries in congenital glaucoma. [accessed 10 September 2014]; clinicaltrials.gov/show/NCT01460017.
    1. NCT01494974. Comparison of the Ahmed glaucoma valve FP7 and FP8 in pediatric glaucoma: a randomized clinical trial. [accessed 10 September 2014]; clinicaltrials.gov/show/NCT01494974.
    1. NCT02121171. Comparative evaluation of combined trabeculotomy-trabeculectomy versus combined trabeculotomy-trabeculectomy with subconjunctival implantation of collagen matrix implant for primary congenital glaucoma. [accessed 11 September 2014]; clinicaltrials.gov/ct2/show/NCT02121171.
    1. CTRI/2014/05/004603. Comparison of illuminated microcatheter circumferential trabeculotomy with combined trabeculotomy-trabeculectomy in primary congenital glaucoma. [accessed 11 September 2014]; apps.who.int/trialsearch/Trial2.aspx?TrialID=CTRI/2014/05/004603.

Additional references

    1. 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. British Journal of Ophthalmology. 2005;89(4):449–453. - PMC - PubMed
    1. Al-Torbaq AA, Edward DP. Delayed endophthalmitis in a child following an Ahmed glaucoma valve implant. Journal of AAPOS. 2002;6(2):123–125. - PubMed
    1. Allingham RR, Damji KF, Freedman S, Mori SE, Shafranov G, editors. Shield’s Textbook of Glaucoma. 5th Edition. Philadelphia: Lippincott Williams and Wilkins; 2005. Congenital glaucoma; pp. 235–252.
    1. Allingham RR, Damji KF, Freedman S, Mori SE, Shafranov G, editors. Shield’s Textbook of Glaucoma. 5th Edition. Philadelphia: Lippincott Williams and Wilkins; 2005. Medical and surgical treatment for childhood glaucomas; pp. 623–643.
    1. Amer SAK, Saif MYS, Saif ATS, Saif PS. Variations of cup-to-disc ratio in children. Open Journal of Ophthalmology. 2014;4:12–17.

References to other published versions of this review

    1. Ghate D, Kedar S. Surgical interventions for primary congenital glaucoma. Cochrane Database of Systematic Reviews. 2010;(1) - PMC - PubMed

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