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Improving long-term intraocular pressure and visual outcomes in eyes with aniridic glaucoma

Abstract

Purpose

To study the long-term intraocular pressure (IOP) and visual outcomes in treated aniridic glaucoma.

Methods

A retrospective chart review of patients with aniridia and glaucoma, with ≥ 2-year follow-up, was performed. Eyes in early glaucomatous stages were medically managed, while moderate-severe stage eyes underwent a trabeculectomy with mitomycin-c (MMC). Success was termed ‘complete’ when average final IOP was ≤ 18 mmHg without usage of glaucoma medications, and ‘qualified’ when with/without topical glaucoma therapy. A significant change in vision was defined as > 2-line change on Snellen vision chart or > 0.2 change in logMAR units in in either direction (better or worse).

Results

Thirty-five eyes of 20 patients were included. The mean duration of follow-up was 7.29 ± 5.75 years. Associated ocular anomalies were present in 19 eyes (54.29%). Twelve eyes (34.28%) were maintained on medical management, while 23 eyes (65.71%) had undergone a trabeculectomy with MMC. The mean baseline IOP was 31.46 ± 6.34 mmHg, and mean IOP on last follow-up was 13.25 ± 5.82 mmHg, p < 0.001. Seventy-five percent of the medically managed eyes achieved an IOP ≤ 18 mmHg. 52.17% and 95.65% of the surgically treated eyes achieved ‘complete’ and ‘qualified’ success respectively. The median best corrected visual acuity (BCVA) at baseline was 1.48(0.6–2) logMAR units and on final follow-up was 1.3 (0.48–5) logMAR units, p = 0.21. Fifty percent of the eyes remained stable, 35.71% showed an improvement and 14.29% a deterioration of > 0.2 logMAR units. Patients with a longer follow-up (> 10 years) and those who had undergone a trabeculectomy with MMC were more likely to show good IOP control (p = 0.003; p = 0.004 respectively).

Conclusion

Aniridic glaucoma can be managed efficiently by medications in early glaucomatous neuropathy, and with trabeculectomy augmented with mitomycin-C and releasable sutures for more advanced glaucomas, offering favourable long-term IOP control, visual stability and safety.

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Author information

Affiliations

Authors

Contributions

Conceptualization: Ramanjit Sihota, Tanuj Dada.

Methodology: Ramanjit Sihota, Harathy Selvan, Kishan Azmira.

Formal analysis and investigation: Ramanjit Sihota, Harathy Selvan, Ajay Sharma, Amish Gupta, Ashish Upadhyay.

Writing–original draft preparation: Harathy Selvan.

Writing–review, editing and final approval: All authors.

Supervision: Ramanjit Sihota, Tanuj Dada.

Corresponding author

Correspondence to Harathy Selvan.

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Research involving human participants

An informed consent was taken from adult participants and legal guardian of all pediatric patients to participate and publish the results of the study. All procedures performed in this study involving human participants was in accordance with the ethical standards of the institutional Ethics committee, All India Institute of Medical Sciences, New Delhi, India, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflicts of interest

The authors declare no competing interests.

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Sihota, R., Selvan, H., Azmira, K. et al. Improving long-term intraocular pressure and visual outcomes in eyes with aniridic glaucoma. Graefes Arch Clin Exp Ophthalmol (2021). https://doi.org/10.1007/s00417-021-05335-5

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Keywords

  • Aniridia
  • Aniridic glaucoma
  • Aniridia with glaucoma
  • Trabeculectomy with mitomycin-c
  • Releasable suture