Comparison of the Intraocular Pressure-lowering Effects of Three Primary Surgical Procedures in Pediatric Aphakic Glaucoma

Abstract

Aims and background: We aimed to compare the effects of ab externo trabeculotomy (AbE-TLO), gonioscopy-assisted transluminal trabeculotomy (GATT), and Ahmed glaucoma valve (AGV) implantation on intraocular pressure (IOP) and the number of antiglaucomatous medications used in pediatric aphakic glaucoma (AG).

Materials and methods: Between 2017 and 2022, 27 eyes of 24 children who underwent AbE-TLO, GATT, and AGV in our clinic for pediatric AG were retrospectively analyzed. Corneal dimensions, corneal thickness, axial length, and surgical technique were recorded. Baseline and postoperative follow-up IOP measurements and antiglaucomatous drops used were analyzed.

Results: AbE-TLO was performed in 37% (n = 9), GATT in 30% (n = 7), and AGV implantation in 33% (n = 8) of the patients included in our study. The mean follow-up period was 39.12 ± 3.19 months. In the 2nd postoperative year, IOP decreased significantly from 33.9 to 17.7 mm Hg with AbE-TLO (p = 0.014), from 34.3 to 18.3 mm Hg with GATT (p = 0.033), and from 34.5 to 16.4 mm Hg with AGV (p = 0.002). When all three surgical methods were compared, no significant difference was observed in IOP reduction at 1 and 2 years (p > 0.05). The number of antiglaucomatous medications decreased from 2.3 to 0.8 (p = 0.005) in AbE-TLO, from 2.4 to 0.5 (p = 0.008) in GATT, and from 2.3 to 0.6 (p = 0.005) in AGV at 2 years after surgery.

Conclusion: There was a significant decrease in IOP, along with a significant reduction in the usage of antiglaucomatous drugs, across all three primary surgical methods. No significant difference was detected regarding the reduction in IOP and the usage of antiglaucomatous medications.

Clinical significance: Approximately, half of the patients with pediatric AG undergo surgery. However, the most appropriate surgical technique for AG remains unclear. Minimally invasive glaucoma surgeries, increasingly performed in recent years, now constitute a pivotal aspect of glaucoma surgical treatment. Thus, the main objective of the current research is to compare the impacts of AbE-TLO, GATT, and AGV implantation on IOP as the primary surgical method in pediatric AG.

How to cite this article: Toptan M. Comparison of the Intraocular Pressure-lowering Effects of Three Primary Surgical Procedures in Pediatric Aphakic Glaucoma. J Curr Glaucoma Pract 2025;19(1):50-54.

Keywords: Ab externo trabeculectomy; Ahmed glaucoma valve; Gonioscopy-assisted transluminal trabeculectomy; Minimally invasive glaucoma surgery; Pediatric aphakic glaucoma.

Fig. 1:

Comparison of preoperative and postoperative years 1 and 2 IOP values by operative surgical groups; *p < 0.05; **p < 0.01

Fig. 2:

Comparison of the number of glaucoma medications in preoperative and postoperative year 2 by operative groups; *p < 0.05; **p < 0.01