Surgical results of combined trabeculotomy-trabeculectomy for developmental glaucoma.

OBJECTIVE: The purpose of the study was to evaluate the surgical outcome of combined trabeculotomy-trabeculectomy in different types of primary developmental glaucomas. DESIGN: A retrospective review of all cases of primary developmental glaucomas that underwent primary combined trabeculotomy-trabeculectomy between August 1990 and September 1995, with a minimum follow-up of 6 months, was performed. PARTICIPANTS: One hundred and eighty-two eyes of 120 patients were included in this study; 122 (67%) eyes had congenital glaucoma; 22 (12.1%) eyes had infantile glaucoma; and 38 (20.9%) eyes had juvenile glaucoma. INTERVENTION: Primary combined trabeculotomy-trabeculectomy was the chosen intervention. MAIN OUTCOME MEASURES: Preoperative and postoperative intraocular pressures, visual acuities, success rate, corneal clarity and diameters, bleb characteristics, time of surgical failure, and complications were the main outcome measures. RESULTS: Intraocular pressure (mean +/- SD) reduced from a preoperative level of 26.5 +/- 8.3 mmHg; 30.3 +/- 9.9 mmHg; and 31.8 +/- 11.5 mmHg to 13.1 +/- 5.8 mmHg; 13.7 +/- 4.4 mmHg; and 13.3 +/- 6.0 mmHg in the congenital, infantile, and juvenile types of developmental glaucomas, respectively. Kaplan-Meier survival analysis showed that the success probability at 6 months was 94.4% +/- 2.3%; 90.9% +/- 6.1%; and 81.0% +/- 7.3% in the three groups, respectively. The success probability of patients with juvenile glaucoma was significantly lower than it was for those with congenital glaucoma (P = 0.0393). Of 182 eyes, 105 (57.7%) eyes had corneal edema at presentation. Eighty-one (79%) of 105 eyes had complete clearance of corneal edema postoperatively (P < 0.0001). The follow-up period ranged from 6 months to 48 months (mean, 10.7 +/- 12.0 months). There were no sight-threatening intraoperative and postoperative complications in any patient. CONCLUSIONS: Primary combined trabeculotomy-trabeculectomy is safe, effective, and sufficiently predictable to be considered the first choice of surgical treatment in primary congenital glaucoma with corneal edema. Juvenile glaucoma has the worst prognosis, and infantile glaucoma has a better prognosis than does juvenile glaucoma.

Mitomycin C-augmented trabeculectomy in refractory congenital glaucoma.

OBJECTIVE: The purpose of the study is to determine the safety and efficacy of mitomycin C-augmented trabeculectomy in children with developmental glaucoma treated previously by conventional procedures. DESIGN: Retrospective review of all cases of developmental glaucoma with previously failed conventional procedures that underwent mitomycin C-augmented trabeculectomy between January 1992 and December 1994. PARTICIPANTS: A total of 19 eyes of 13 patients were included in the study. Nineteen eyes included primary congenital glaucoma (15 eyes) with documented failure of primary trabeculotomy, Axenfeld-Reiger syndrome (2 eyes) and aniridia (2 eyes). INTERVENTION: Mitomycin C-augmented (0.4 mg/ml for 3 minutes) trabeculectomy was the chosen intervention. MAIN OUTCOME MEASURES: Preoperative and postoperative intraocular pressures (IOPs), visual acuities, success rate, bleb characteristics, time of surgical failure, and complications were the main outcome measures. RESULTS: The mean IOP was reduced from a preoperative level of 33.74 +/- 10.70 mmHg to 11.89 +/- 1.33 mmHg (P < 0.0001) with the percentage reduction in IOP being 64.75. The mean follow-up was 19.52 +/- 2.65 months. Visual acuity was maintained in all the cases after surgery. Complete success as defined in the authors' study was achieved in 18 eyes (94.74%). Only one patient was classified as a qualified success. The bleb was characterized by its large elevated, avascular, transparent appearance in all the eyes. The only significant complication was retinal detachment in an eye with buphthalmos, aphakia, and large axial length. However, the retina was reattached successfully by retinal reattachment surgery, and visual acuity improved to the preoperative level of 20/200. It was not possible to determine the cause of retinal detachment or to assess the possible role of mitomycin C in this complication. CONCLUSIONS: Mitomycin C-augmented trabeculectomy is a viable option in eyes with failed conventional trabeculotomy surgery.