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Impressum
The risk profile of scleral double-flap dissection for complicated congenital glaucoma
Lüke C., Dietlein T. S., Jacobi P. C., Konen W., Krieglstein G. K.
Zentrum für Augenheilkunde, Universität Köln
Objective: The aim of this observational case series was to evaluate
the effectiveness and the risk profile of scleral double-flap dissection
in pressure-reducing surgery for complicated congenital glaucoma.
Methods: 10 eyes of 8 consecutive patients underwent deep sclerectomy
for complicated congenital glaucoma. The procedure was converted into
a trabeculectomy in 4 eyes and supplemented by a trabeculotomy in 2 eyes.
6 eyes had primary congenital glaucoma and 4 eyes had secondary congenital
glaucoma. The age at the time of surgery in our department ranged from
8 months to 14 years. All eyes had a history of previous glaucoma surgery.The
surgical outcome was assessed in terms of complication rate, IOP change,
need for surgical revision or additional glaucoma medication.
Results: Preoperatively the mean IOP was 31.9 mmHg (SD 5.6 mmHg).
At first follow up -one week post surgery-, the mean postoperative IOP
for all eyes was 12.7 mmHg (SD 6.8 mmHg) (p < 0.001). In accordance
with the success criteria all eyes had to be classified as failures. Specific
complications were non-identification of Schlemm`s canal (40 %), choroidal
deroofing (10 %), and visible perforation of the trabeculodescemetic membrane
(20 %). Further complications were seen in terms of hyphema (40 %), ocular
hypotony (10 %), vitreous hemorrhage (10 %), and vitreous loss with subsequent
retinal detachment (10 %).
Conclusions: Our data clearly points to a specific risk profile
associated with scleral double-flap dissection in pressure-reducing surgery
for complicated congenital glaucoma.