Authors: Sharon Armarnik, Stephen Farrell, Christopher J Lyons

Author Disclosure Block: S. Armarnik: None. S. Farrell: None. C. Lyons: None.

Abstract Body:

Purpose: Glaucoma is an uncommon condition in childhood. Goniotomy is an attractive surgical solution since it is conjunctival-sparing, quick and relatively safe. We have used this technique across the whole spectrum of childhood glaucoma and report its long-term results for each condition. 

Study Design: A retrospective, non-randomized, non-interventional, single center study Methods: The charts of all children undergoing goniotomy from 2000 to 2018 were included in the study. Patients were excluded if they had previous glaucoma surgery at the time of the initial goniotomy, and if follow-up was less than 6 months. We defined complete success as final intraocular pressure (IOP) 21 mm Hg or less after one or two goniotomies without medications. Qualified success was defined as IOP of no greater than 21 mm Hg with medications. Failure was defined as IOP greater than 21 mm Hg despite medical therapy, requiring further surgical intervention. 

Results: 90 eyes of 61 patients which had undergone initial goniotomy were included in this study. The mean age at initial surgery was 5.1 ± 4.8 years (range 37 days to 15.7 years, median 2.7 years). 34 eyes had a diagnosis of Primary Congenital Glaucoma (PCG), 16 of Juvenile open angle glaucoma (JOAG), 18 of Uveitic Glaucoma, 11 of Anterior Segment dysgenesis or Aniridia, 7 of Sturge Weber (SWS) or Klippel Trenaunay Weber Syndrome, and 4 of Aphakia. Mean follow up was 6.6 ± 4.4 years (Range 0.5 to 17 years). At the last follow up appointment 52 eyes (58%) were a complete success following either 1 or 2 goniotomy procedures without any pressure lowering medications, 8 eyes (9%) were a qualified success and 33% had failed to be controlled by goniotomy and required another surgical procedure. Complete success rates were as follows: PCG:85%, JOAG:31%, Uveitic glaucoma:67%, SWS / Klippen Trenaunay:0%, Anterior Segment Dysgenesis / Aniridia:45% and Aphakia:25%. When combining complete and partial success for PCG, JOAG and Uveitis the percentages are as followed 88%, 62% and 77%. One infant with PCG with unsuspected bleeding diathesis required surgical evacuation of a post-operative hyphema. 

Conclusions: We found goniotomy to be very effective and safe for the treatment of primary congenital glaucoma and uveitic glaucoma in Western Canada. It was also successful in a high number of JOAG and patients with aniridia or ASD, but not in SWS / Klippel -Treanaunay syndrome. Long-term survival analysis of our children showed goniotomy results to be largely stable after the initial 6-month post-operative period with few failures beyond that period, though careful long-term follow-up remains indicated.