OBJECTIVE: To evaluate the safety and effectiveness of trabeculectomy with mitomycin C in the management of childhood glaucoma. INTRODUCTION: The use of antifibrotic agents enhances the success of trabeculectomy performed in both adults and children. METHODS: A retrospective chart review (1991-2001) of 114 patients (114 eyes) from 0-14 years of age with congenital or developmental glaucoma. These patients underwent trabeculectomy with mitomycin but had not been previously treated with any antifibrotic agent. RESULTS: The mean patient age was 57.36 51.14 months (range: 0.5-168 months). Treatment was considered successful in 63 eyes (55.26%), with a mean intraocular pressure of 12.11 3.98 mmHg. For patients categorized as successfully treated, the mean follow-up time was 61.16 26.13 months (range 12-113 months). A post-surgical intraocular pressure of < 16 was observed in 47 eyes. The life-table success rates for intraocular pressure control at 24, 36, 48, and 60 months were 90.2%, 78.7%, 60.7% and 50.8%, respectively. The cumulative probability of failure was 40.8% at 12 months. Following surgery, endophthalmitis appeared in eight eyes (4.88%) after an average 36.96 months (range: 1.7-106 months). Other complications included expulsive hemorrhage, flat anterior chamber and bleb leak. DISCUSSION: It has been reported in pediatric patients that trabeculectomy without adjunctive antimetabolites achieves a successful outcome in 30% to 50% of cases. In our study, treatment was considered successful in 63 eyes (55.26%) within 61.16 26.13 months of follow-up. CONCLUSIONS: Trabeculectomy with mitomycin is safe and effective for short-term or long-term treatment of congenital or developmental glaucoma. The frequency of bleb-related endophthalmitis was no higher in these patients than that described in adults.
Purpose: To determine the fiber layer analyzer GDx's specificity in a group of normal subjects, and the most altered parameters for this group. Methods: Normal patients were examined (complete ophthalmologic examination) and then we performed the fiber layer analysis with NFA- GDx (LDT). Total: 34 randomly selected eyes. Results and Conclusion: The specificity was 58.8%, and the corrected specificity 70.5%. The most altered parameter was symmetry (85.71%), and the less altered, the inferior and superior ratio (0%). When we have an isolated altered symmetry in a patient with normal IOP and normal optic disc, the false-positive diagnosis must be remembered; when a suspected glaucoma patient has an altered inferior ratio, glaucoma diagnosis must be remembered.
Objetivos: Determinar a especificidade do analisador de fibras nervosas- GDx em um grupo de pacientes normais, assim como os índices que mais comumente mostram-se alterados em pacientes deste grupo. Métodos: Foram submetidos a exame oftalmológico completo 50 pacientes normais (não-glaucomatosos) e na seqüência obtida a análise da camada de fibras nervosas destes pacientes, utilizando-se o software GDx (LDT). Foram excluídos os olhos que não perfaziam os critérios de inclusão e utilizado apenas um olho de cada paciente após randomização, perfazendo um total de 34 olhos. Resultados e Conclusões: Obtivemos 20 exames normais e 14 exames alterados. O índice com maior freqüência de alteração foi a simetria (85,71%), e os com menor freqüência "inferior ratio" e "superior ratio" (0% cada). A especificidade obtida foi de 58,8%, elevando-se para 70,5% após correção e análise dos dados. Devemos levantar a hipótese de um exame-falso positivo quando um paciente com exame ocular normal mostrar a simetria como único índice alterado ao GDx , e lembrar do diagnóstico de glaucoma quando um paciente suspeito apresentar alteração de"inferior ratio".