Long-term surgical outcomes of primary congenital glaucoma in China

OBJECTIVE: To evaluate the long-term outcomes of three surgical procedures for the treatment of primary congenital glaucoma (PCG). INTRODUCTION: PCG is one of the main causes of blindness in children. There is a paucity of contemporary data on PCG in China. METHODS: A retrospective study of 48 patients (81 eyes) with PCG who underwent primary trabeculectomy, trabeculotomy, or combined trabeculotomy and trabeculectomy (CTT). RESULTS: All patients were less than 4 years (yrs) of age, with a mean age of 2.08 ¡À 1.23 yrs. The mean duration of follow-up was 5.49 ¡À 3.09 yrs. The difference in success rates among the three surgical procedures at 1, 3, 6 and 9 yrs was not statistically significant (p = 0.492). However, in patients with over 4 yrs of follow-up, Kaplan-Meier survival analysis revealed that the success rates of trabeculectomy and CTT declined more slowly than that of trabeculotomy. Among the patients, 66.22% acquired good vision (VA ¡Ý 0.4), 17.57% acquired fair vision (VA = 0.1 - 0.3), and 16.22% acquired poor vision (VA < 0.1). The patients with good vision were mostly in the successful surgery group. Myopia was more prevalent postoperatively (p = 0.009). Reductions in the cup-disc ratio and corneal diameter were only seen in the successful surgery group (p = 0.000). In addition, the successful surgery group contained more patients that complied with a regular follow-up routine (p = 0.002). DISCUSSION: Our cases were all primary surgeries. Primary trabeculectomy was performed in many cases because no treatment was sought until an advanced stage of disease had been reached. CONCLUSIONS: In contrast to most reports, in the present study, trabeculectomy and CTT achieved higher long-term success rates than trabeculotomy. The patients with successful surgical results had better vision. Compliance with a routine of regular follow-up may increase the chances of a successful surgical outcome.

Clinical Observation of Combined Trabeculotomy and Trabeculectomy on Congenital Glaucoma

PURPOSE: To investigate the result of combined trabeculotomy and trabeculectomy as an initial operative treatment of congenital glaucoma. METHODS: We retrospectively reviewed the medical records of 8 patients (14 eyes) who were operated with combined trabeculotomy and trabeculectomy as an initial operative treatment of congenital glaucoma from October 13, 1998 to February 20, 2001. The mean age of patients was 1.2 years (ranging from 0.75 to 2 years) and the mean follow-up period was 12.4 months (12.3+/-8.18). We assessed the mean age at surgery, preoperative corneal diameter, preoperative and postoperative intraocular pressure, preoperative and postoperative C/D ratio, postoperative complications. RESULTS: The mean age at first surgery was 4.4 months (4.3+/-2.45), the mean postoperative intraocular pressure (IOP) at the end of follow-up period was 13.2+/-2.01mmHg, significantly lower than the mean preoperative IOP which was 25+/-5.23mmHg (P<0.05), the mean postoperative C/D ratio at the end of follow-up period was 0.38+/-0.14, significantly lower than the mean preoperative C/D ratio which was 0.55+/-0.15 (P<0.05), C/D ratio of 3 eyes among them was decreased by more than 0.2. The overall success rate was 71.4% (10 eyes) after single procedure. All the 4 failed eyes underwent trabeculectomy again and the IOP was well controled. The complications included hyphema(5 eyes), corneal edema (3 eyes), vitreous prolapse (3 eyes), posterior synechiae (2 eyes), and they were all resolved spontaneously. CONCLUSIONS: The combined surgery of trabeculotomy and trabeculectomy as an initial single procedure of congenital glaucoma lowered the IOP without serious complications.