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Outcomes of surgical interventions for primary childhood glaucoma in Northern Tanzania
  1. Achim Fieß1,
  2. Godfrey Furahini2,3,
  3. Richard Bowman3,
  4. Jacqueline Bauer4,
  5. Stefan Dithmar1,
  6. Heiko Philippin2,3
  1. 1Department of Ophthalmology, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
  2. 2Department of Ophthalmology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
  3. 3Faculty of Infectious & Tropical Diseases, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
  4. 4Paediatric Department, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
  1. Correspondence to Dr Achim Fieß, Department of Ophthalmology, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Ludwig-Erhard-Straße 100, Wiesbaden 65199, Germany; Achim.Fiess{at}helios-kliniken.de

Abstract

Aim To evaluate goniotomy, trabeculotomy, transscleral cyclophotocoagulation (TSCPC) and trabeculectomy as initial procedures in children with primary childhood glaucoma from Northern Tanzania.

Methods A retrospective analysis of consecutive interventions for primary childhood glaucoma from 2000 to 2013 was conducted at the Kilimanjaro Christian Medical Centre. Success was defined as postoperative intraocular pressure (IOP) below 22 mmHg. Success rates, IOP, visual acuity (VA), subsequent interventions and potential risk factors for failure were reported for the respective interventions.

Results The study included 116 eyes of 70 children (age 4.6±5.9 years) with primary childhood glaucoma; 46 (65.7%) children were male. The preoperative IOP was 33.1±10.2 mmHg, the preoperative cup/disc (CD) ratio 0.71±0.3 and the corneal diameter 13.3±1.4 mm. As a primary intervention, 61 (52.6%) eyes underwent goniotomy, 10 (8.6%) eyes trabeculotomy, 12 (10.3%) TSCPC and 33 (28.4%) trabeculectomy. Follow-up data after 12 months were available for 63 (54.3%) eyes. Success rates at 12 months were 38% (goniotomy), 30% (trabeculotomy), 17% (TSCPC) and 64% (trabeculectomy). All interventions achieved a statistically significant IOP reduction at 3, 6 and 12 months, except for trabeculotomy after 6 months and TSCPC at all time points. Postoperative endophthalmitis occurred in one child treated with trabeculectomy. VA in 82% of all eyes was maintained or had improved after 12 months.

Conclusions Based on the success rates of this retrospective analysis, goniotomy or trabeculotomy for younger and trabeculectomy for older children can be recommended in our setting to reduce IOP. Late presentation in combination with advanced glaucomatous damage as well as erratic postoperative follow-up and treatment were likely factors that compromised overall success rates. More efforts are necessary to detect the blinding disease earlier and improve adherence to follow-up.

  • Child health (paediatrics)
  • Glaucoma
  • Low vision aid
  • Optic Nerve
  • Public health

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Footnotes

  • Contributors Corresponding author AF. AF and HP designed the study. HP designed and programmed the database, AF and HP did the data acquisition and AF performed the statistical analysis. All authors interpreted the data. AF drafted the manuscript, all authors revised it critically and approved the final version. All authors agreed to be accountable for all aspects of the work.

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained from the local ethics committee of Kilimanjaro Christian Medical University College, Moshi, Tanzania.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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