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Long-term surgical and visual outcomes in Indian children with developmental glaucoma operated on within 6 months of
Anil K Mandal1, Prashant G Bhatia, Arumugam Bhaskar
1Jasti V. Ramanamma Children's Eye Care Centre, L. V. Prasad Eye Institute, Hyderabad, India. mandal@lvpei.org
Insights
Primary combined trabeculotomy-trabeculectomy is a safe and effective surgery for developmental glaucoma in infants. This procedure offers excellent intraocular pressure control and moderate visual outcomes when performed within the first six months of life.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Developmental glaucoma requires early surgical intervention for optimal outcomes.
- Infantile glaucoma presents unique challenges due to the developing ocular structures.
Purpose of the Study:
- To evaluate the long-term surgical and visual results of primary combined trabeculotomy-trabeculectomy in Indian children with developmental glaucoma.
- To assess the safety and efficacy of early surgical intervention (within 6 months of birth) for developmental glaucoma.
Main Methods:
- A retrospective case series of 157 consecutive patients (299 eyes) with developmental glaucoma operated within 6 months of birth.
- Primary combined trabeculotomy-trabeculectomy was performed by a single surgeon over a 12-year period.
- Key outcome measures included intraocular pressure (IOP), corneal clarity, visual acuity, and complications.
Main Results:
- Mean IOP reduced significantly from 26.6 mmHg to 14.4 mmHg post-surgery (P<0.0001).
- Surgical success rate (IOP<21 mmHg) remained above 70% through the sixth year post-operation.
- Postoperative corneal clarity improved in 62.4% of eyes with preoperative edema, with no sight-threatening complications.
Conclusions:
- Primary combined trabeculotomy-trabeculectomy is a safe and effective surgical option for developmental glaucoma in infants.
- Early surgical intervention within 6 months of birth leads to sustained intraocular pressure control.
- The procedure results in moderate visual outcomes and a low rate of serious complications.
Purpose:
To determine the long-term surgical and visual outcomes in Indian children with developmental glaucoma operated within 6 months of birth.
Design:
Retrospective consecutive, noncomparative case series.
Participants:
All children with developmental glaucoma who underwent surgery within 6 months of birth over a 12-year period were included.
Methods:
Two hundred ninety-nine eyes of 157 consecutive patients who underwent primary combined trabeculotomy-trabeculectomy for developmental glaucoma from January 1990 through December 2001 by a single surgeon were studied. However, for the purpose of statistical analysis, only 1 randomly chosen eye of patients with a bilateral affliction (142, 90.4%) was considered.
Main Outcome Measures:
The main outcome measures were preoperative and postoperative intraocular pressures (IOPs), corneal clarity and diameters, visual acuities, refractive errors, success rate, time of surgical failure, and complications.
Results:
The series consisted of 299 primary combined trabeculotomy-trabeculectomy surgeries during 157 anesthesias. The intraocular pressure was reduced from 26.6+/-6.2 mmHg to 14.4+/-4.9 mmHg, with a mean percentage reduction of 41.1+/-28.8 (P<0.0001). The probability of success (IOP<21 mmHg) was 94.4%, 92.1%, 86.7%, 79.4%, 72.9%, and 63.1% at first, second, third, fourth, fifth, and sixth year, respectively (Kaplan-Meier analysis). The mean follow-up period was 26.5+/-25.1 months. Preoperatively, 133 eyes (84.7%) had significant corneal edema. Postoperatively, normal corneal clarity was achieved in 83 of 133 eyes (62.4%) with corneal edema. There were no major intraoperative complications. Postoperatively, 17 eyes (10.8%) had a shallow anterior chamber develop; 3 of these eyes (17.6%) required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Data on visual acuity were available in 49 patients (31.2%). At the final follow-up visit, 20 patients (40.8%) had normal visual acuity (best-corrected visual acuity of >/=20/60 in the better eye).
Conclusions:
Primary combined trabeculotomy-trabeculectomy is safe and effective for developmental glaucoma when performed within 6 months of birth. It leads to excellent IOP control and moderate visual outcome.
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