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概要

Comparison of the Clinical Profiles of Patients with Childhood Glaucoma Based on Refractoriness to Angular Surgery in a Public Hospital in Brazil

Juliana Angelica Estevao de Oliveira*, Flavia da Silva Villas-Boas, Iluska Andrade Agra

Objective: This study aims to provide more information about childhood glaucoma by comparing the profile of refractory and non refractory cases to angular surgery in a public hospital in Brazil.

Methodology: Retrospective cross sectional study carried out by collecting data from electronic medical records of all patients under 18 years of age who underwent surgical procedures for glaucoma between August 1, 2018, and January 31, 2021, in a childhood glaucoma department of a public hospital in Brazil. For this study, refractory childhood glaucoma included children who failed to respond or responded poorly to surgical angle procedures. Surgical success was defined as intraocular pressure equal to or less than 21 mmHg and greater than 5 mmHg with or without glaucoma medications. Failure was defined as intraocular pressure being outside of the successful range on two consecutive visits. The profiles of refractory and non refractory patients were compared according to the following data: Gender; age, laterality and type of glaucoma, clinical history, family history of glaucoma, procedures performed, intraocular pressure levels, ocular axial length, horizontal diameter and corneal opacity, vertical cupping of the optic nerve, presence of postoperative complications requiring intervention surgical.

Results: Most refractory eyes belonged to male patients (71%), with bilateral glaucoma (93%), of the primary type (93%, p=0.02). They had lower IOP at the end of the study (11.85 mmHg; p=0.007), had no variation of the vertical cupping of the optic disc from the preoperative to the end of study (p=0.02), and more postoperative complications (28.6%; p=0.02). All fourteen refractory eyes had IOP below 18 mmHg at the end of the study and 53% of them required hypotensive eye drops.

Conclusion: The present study proved that angular surgery, when possible, is the best initial surgical option, resolving most cases with fewer complications than filtering surgeries. More prospective data is needed to improve the surgical management of childhood glaucoma.