Surgical management of childhood glaucoma cases at The Eye Foundation Hospitals Group, Nigeria

Abstract

Background: A few studies1 have been carried out on congenital glaucoma as well as surgical outcomes 2,3,4 using combined trabeculotomy-trabeculectomy in developing countries including those in sub–Saharan Africa. This hospital-based study is a review of all types of glaucoma seen in children at a tertiary facility in Nigeria as well as the surgical outcomes. The aim of this study was to identify the demographics, causes and outcomes of surgical management of pediatric glaucoma seen at a private eye hospital setting in Nigeria.

Methods: A retrospective review of the records of children seen at the Eye Foundation Hospitals Group presenting with glaucoma who had
combined trabeculotomy-trabeculectomy over a 5- year study period (2018-2023). Data on their demographic characteristics, diagnosis, and
Intraocular pressure (IOP) before and after surgery was collected with the aid of proforma. All the children under went combined trabeculotomy-trabeculectomy under general anesthesia with serial examinations postoperatively. Data was descriptively analysed.

Results: Forty-five eyes of 25 patients were studied. Eighteen (72%) patients were male and seven (28%) were female. Seventeen (68%)patients were between the ages of 0-12 months, eight (32%) patients were between ages 2-12 years with four (50%) between 2-4 years. Eighteen (72%) patients were diagnosed with primary congenital glaucoma, three (12%) had post traumatic glaucoma, two (8%) had secondary glaucoma post lensectomy, while developmental glaucoma was diagnosed in one (4%) patient. The average corneal diameter was 12.4mm. The cup disc ratios ranged between 0.1-0.9 in 25 (55%) eyes. Twenty- six eyes had pre- and post-operative IOP measurements. The preoperative IOPs ranged from 6 to 54mmHg with a mean of 24.5mmHg. Eleven (42.3%) eyes had preoperative IOP of 21- 43mmHg while 15(57.7%) eyes had between 6- 20mmHg. Twenty-four (92.3%) eyes had reduction in IOP post-operatively. Twenty-three (88.5%) eyes achieved >21% reduction in pre-operative IOP with a mode of 63% reduction. Three (11.5%) eyes had IOP reduction of < 7%. Approximately
31% of the eyes were hypermetropic while 69% were myopic.Average follow up period was 19.1 months with a range between 1–60 months. The corneas cleared up except 4 patients with residual dense corneal opacities.

Discussion: The common pattern of presentation of the disease in African children is a cloudy cornea which may hinder good visualization of the anterior chambers for angle surgery. Essuman et al 3 reviewed a series of cases among Ghanaian children with good outcomes in 79% of 19 eyes which was lower in comparison to what was obtained in this study (92.3% ) having significant reduction in the intraocular pressures post operatively. A study by Ugalahi et al2 also showed good outcomes with significant reduction in the intraocular pressures in 92.9% of cases after a 12 month follow up period. Corneal cloudiness also cleared in more than 80% of cases reviewed which was comparable with our findings of 91.1% of the corneas clearing up post operatively.

Conclusion: Pediatric glaucoma is commoner in boys than girls. Congenital glaucoma is the commonest type. Combined trabeculotomy-
trabeculectomy is effective in reducing the intraocular pressures and improving corneal clarityin African children.