Serhat İMAMOĞLU, Mehmet Şahin SEVİM, GÖKHAN PEKEL, Hüseyin Avni SANİSOĞLU

Primer Konjenital Glokomda Trabekülotomi ile Kombine Mitomisinli Trabekülektomi Sonuçlarımız

Amaç: Primer konjenital glokomlu çocuklarda trabekülotomi ile kombine mitomisinli trabekülektomi ameliyatının etkinliğinin değerlendirilmesidir Materyel ve Metod: 3 Primer konjenital glokom tanısı ile trabekülotomi ile kombine mitomisinli trabekülektomi ameliyatı uygulanan 7 hastanın 13 gözünün kayıtları retrospektif olarak incelendi. İstatistiksel analiz için SPSS 15.0 yazılım programı kullanıldı. Preoperatif ve postoperatif göz içi basıncı değerleri Wilcoxon ilişkili iki örneklem testi ile kıyaslandı. Bulgular: Haziran 2006-Mayıs 2012 tarihleri arasında opere edilen 7 hastanın (4 erkek, 3 kız; yaş ortalaması 30,6 ± 22,4 ay) 13 gözü çalışmaya alındı. İlk tanı yaşı 2,6 ± 1,1 (1-4) ay ve ilk cerrahi uygulama yaşı 5,3 ± 4,0 (1-12) ay idi. Yedi olgunun 6'sının hastalığı bilateral idi. Ortalama takip süresi 25,9 ± 22,6 (1-54) ay olarak saptandı. Preoperatif ortalama horizontal kornea çapı 13,4 ± 0,9 (12-15) mm idi. Hastaların %53'ünde kornea ödemi mevcuttu. Kombine cerrahi uygulanan gö- zlerin % 53,8'inde (7 göz) cerrahi başarı (göz içi basıncı < 21 mm Hg) sağlanırken bu oran ek cerrahiler ile % 76,9'a (10 göz) çıktı. Bir hastada prefitizis bulbi gelişti. Sonuçlar: Primer konjenital glokom tedavisinde trabekülotomi ile kombine mitomisinli trabekülektomi etkin bir cerrahi olmasına rağmen, ek glokom cerrahileri ile başarı oranları daha da yükselmektedir.

Surgical Results of Combined Trabeculotomy - Trabeculectomy with Mitomycin C for Primary Congenital Glaucoma

Objective: To evaluate the effectiveness of combined trabeculotomy-trabeculectomy with mitomycin C for primary congenital glaucoma Methods: The medical records of 7 patients’ 13 eyes with primary congenital glaucoma who had combined trabeculotomy-trabeculectomy with mitomycin C were reviewed. SPSS 15.0 software for Windows® was used for statistical analysis. Preoperative and postoperative intraocular pressures were compared with Wilcoxon signed rank test. Results: Thirteen eyes of 7 (4 male, 3 female; mean age 30.6 ± 22.4 months) patients who was operated between June 2006- May 2012 were included into the study. The mean time of first presantation was 2.6 ± 1.1 (1-4) months, whereas the mean time of first surgery was 5.3 ± 4.0 (1-12) months. Six patients had bilateral disease. Mean follow-up time was 25.9 ± 22.6 (1-54) months. Mean corneal horizontal diameter was 13.4 ± 0.9 (12-15) mm. Corneal edema was found in 53 % of the patients. The surgical success rate (intraocular pressure < 21 mm Hg) of eyes with combined surgery alone was 53.8 %, however this ratio was incresed to 76.9 % when additional surgeries were performed. Conclusion: Even though combined trabeculotomy-trabeculectomy with mitomycin C is an effective surgical option for primary congenital glaucoma, the surgical success rate is increased with additional surgeries

PDF

___

1. Ho CL, Walton DS. Primary congenital glaucoma: 2004. J Pediatr Ophthalmol Strabismus 2004; 41: 271–288.
2. Papadopoulos M, Khaw PT. Childhood glaucoma. In: Taylor D, Hoyt CS (eds). Pediatric Ophthalmology Strabismus. Elsevier Saunders: Philadelphia, 2005, pp 458–471.
3. Papadopoulos M, Khaw PT. Advances in the management of paediatric glaucoma. Eye 2007; 21(10): 1319–1325.
4.Allingham RR. Medical and surgical treatment of childhood glaucoma. In: Shields’s Textbook of Glaucoma, 5th edn. Lippincott Williams and Wilkins: Philadelphia, 2005, p 626.
5. deLuise VP, Anderson DR. Primary infantile glaucoma (congenital glaucoma). Surv Ophthalmol 1983; 28: 1–19.
6. Russell-Eggitt IM, Rice NS, Jay B, Wyse RK. Relapse following goniotomy for congenital glaucoma due to trabecular dysgenesis. Eye 1992; 6: 197–200.
7. Luntz MH. The advantages of trabeculotomy over goniotomy. J Pediatr Ophthalmol Strabismus 1984; 21: 150–153.
8. McPherson Jr SD, Berry DP. Goniotomy vs external trabeculotomy for developmental glaucoma. Am J Ophthalmol 1983; 95: 427–431.
9. Beauchamp GR, Parks MM. Filtering surgery in children: barriers to success. Ophthalmol. 1979;86:170-80.
10. Inaba Z. Long-term results of trabeculectomy in the Japanese: an analysis by life-table method. Jpn J Ophthalmol 1982;26:361-73.
11. Gressel MG, Heuer DK, Parrish II RK. Trabeculectomy in young patients. Ophthalmol. 1984;91:1242-6.
12. Debnath SC, Teichmann KD, Salamah K. Trabeculectomy versus trabeculotomy in congenital glaucoma. Br J Ophthalmol. 1989;73:608-11.
13. Burke JP, Bowell R. Primary trabeculectomy in congenital glaucoma. Br J Ophthalmol. 1989;73:186-90.
14. Gressel MG, Parrish II RK, Folberg R. 5-Fluorouracil and glaucoma filtering surgery. I. An animal model. Ophthalmol. 1984;91:378-83.
15. Mallick KS, Hajek AS, Parrish II RK. Fluorouracil (5 FU) and cytarabine (Ara C) inhibition of corneal epithelial cell and conjunctival fibroblast proliferation. Arch Ophthalmol. ;103:1398-402.
16. Litin BS, Jones MA, Kwong EM, Herschler J. Effect of antineoplastic drugs on cell proliferation - individually and in combination. Ophthalmic Surg. 1985;16: 34-9.
17. Mc Guigan LJB, Quigley HA, Lutty G. The effects of D-penicillamine and daunorubicin in conjunctival fibroblast proliferation and collagen synthesis. Invest Ophthalmol Vis Sci. 1988;29:112-8.
18. Yamamoto T, Varani J, Soong HK, Lichter PR. Effects of 5-fluorouracil and mitomycin C on cultured rabbit subconjunctival fibroblasts. Ophthalmol. 1990; 97:1204-10.
19. Zalish M, Leiba H, Oliver M. Subconjunctival injections of 5-fluorouracil following trabeculectomy for congenital and infantile glaucoma. Ophthalmic Surg. 1992;23:203-5.
20. Quigley HA. Results with trabeculotomy and study of reversible cupping. Ophthalmol. 1982;89:219-26.
21. Susanna R, Oltrogge EW, Carani JCE, Nicolela MT. Mitomycin as adjunct chemotherapy in congenital and developmental glaucoma. J Glaucoma. 1995;4: 151-7.
22. Elder MJ. Combined trabeculotomy–trabeculectomy compared with primary trabeculectomy for congenital glaucoma. Br J Ophthalmol 1994; 78: 745–748.
23. Mandal AK. Long-term surgical and visual outcomes in Indian children with developmental glaucoma operated on within 6 months of birth. Ophthalmology 2004; 111: 283–290.
24. Mandal AK, Naduvilath TJ, Jayagandhan A. Surgical results of combined trabeculotomy–trabeculectomy for developmental glaucoma. Ophthalmology 1998; 105: 974–982.
25. Mandal AK, Bhatia PG, Gothwal VK, Reddy VM, Sriramulu P, Prasad MS et al. Safety and efficacy of simultaneous bilateral primary combined trabeculotomy–trabeculectomy for developmental glaucoma in India. Indian J Ophthalmol 2002; 50: 13–19.
26. Mandal AK, Gothwal V, Bagga H, Nutheti R, Mansoori T. Outcome of surgery on infants younger than 1 month with congenital glaucoma. Ophthalmology 2003; 110: 1909–1915.
27. Al-Hazmi A, Awad A, Zwaan J, Al-Mesfer A S, Al-Jadaan I, Al-Mohammed A. Correlation between surgical success rate and severity of congenital glaucoma. Br J Ophthalmol 2005; 89: 449–453.
28. Mandal AK, Matalia JH, Nutheti R, Krishnaiah S. Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14mm or more. Eye 2006; 20: 135–143.
29.Essuman VA, Braimah IZ, Ndanu TA, NtimAmponsah CT.Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population.Eye (Lond). 2011 Jan;25(1):77-83
30. Dureau P, Dollfus H, Cassegrain C, Dufier JL. Long-term results of trabeculectomy for congenital glaucoma. J Pediatr Ophthalmol Strabismus 1998; 35: 198–202.