[Trabeculectomy as the initial procedure in primary congenital glaucoma].

Area of Science:

• Ophthalmology
• Pediatric Surgery

Background:

• Primary congenital glaucoma, or buphthalmos, presents challenges in pediatric eye care.
• Early intervention is crucial for managing elevated intraocular pressure and preventing vision loss.

Purpose of the Study:

• To evaluate the long-term effectiveness of trabeculectomy as a primary surgical treatment for buphthalmic eyes in children.
• To assess the efficacy of trabeculectomy in different age groups of pediatric glaucoma patients.

Main Methods:

• A retrospective study involving 42 eyes of 24 children (7 days to 7 years) with primary congenital glaucoma.
• Forty-five trabeculectomies were performed, with follow-up ranging from 1 to 22 years (mean 82 months).
• Patients were divided into two groups: infants (7 days to 12 months) and older children (3 to 7 years).

Main Results:

• Trabeculectomy achieved normal intraocular pressure (IOP) in 95.2% of eyes.
• Successful IOP normalization was observed in 68.9% of infants and 50% of older children.
• Additional medical treatment was required in some cases, but overall IOP was maintained below 21 mm Hg in 97% of infants and 90% of older children.

Conclusions:

• Trabeculectomy is a safe and effective first-line surgical procedure for primary congenital glaucoma in buphthalmic eyes across a wide pediatric age range.
• The procedure offers long-term IOP stabilization, even in very young infants and neonates, challenging assumptions of poor prognosis.
• Pediatric glaucoma management with trabeculectomy can lead to sustained visual health over many years.