Low Success Rate Reported in Pediatric Glaucoma Procedures

Although angle-based surgery is generally the first choice for childhood glaucoma, bleb-forming procedures were the most common first procedure in this study. Photo: Justin Schweitzer, OD. Click image to enlarge. Childhood glaucoma can lead to irreversible vision loss if not treated promptly. Surgery is often the first-choice treatment, since medications are ineffective and poorly tolerated in these young patients. However, data on surgical outcomes has been limited due to small sample sizes and the low prevalence of the disease. A recent study published in Ophthalmology used a large clinical database to investigate risk factors and visual outcomes following surgery. They reported high failure rates.The retrospective study included children under the age of 18 in the IRIS Registry who underwent a glaucoma-related procedure between 2013 and 2019. The researchers defined procedure failure as follows: an intraocular pressure >21mm Hg; an IOP reduction <20% of baseline; IOP <5 mmHg; any additional IOP-lowering procedure; loss of light perception; removal of eye or chemodenervation; or diagnosis of phthisis bulbi.The researchers reported of the 2,380 eyes in the study, failure occurred in about 45% of eyes at an average of nine months. They identified several factors that were associated with increased risk of failure, including younger age (HR 1.12), higher IOP on index date (HR 1.1), worse visual acuity on index date (HR 1.33), concurrent uveitis (HR 1.41), more glaucoma medications on index date (HR 1.18), systemic IOP-lowering medication (HR 1.71) and complication of hyphema (HR 13.5).They also found that iris-based surgery, iris-based laser and trabecular or angle-based implants were associated with higher failure rates than ab interno angle incision surgery. In nearly 18% of eyes, one or more re-operations were needed.At three years, angle surgery failure rates were 34.5% for primary congenital glaucoma and 39.2% for juvenile open-angle glaucoma. The researchers observed that a higher proportion of eyes with poor visual outcomes were aphakic, used more intense medication and had ocular comorbidities.“Surgical failure was common in nearly half of all cases among 2,380 first-recorded procedures performed for childhood glaucoma, and the most frequent reason for failure was inadequate IOP reduction,” the researchers wrote in their Ophthalmology paper. “Future studies focused on a larger cohort of infantile glaucoma patients (via dedicated clinical registries) may address the knowledge gaps on the outcomes and cost-effectiveness of glaucoma surgery performed on these patients.”Click here for the journal source. Fujita A, Vu DM, Rothman AL, et al. Surgical outcomes and risk factors for failure in childhood glaucoma: analysis of the IRIS Registry. Ophthalmology 2025. [Epub ahead of print].