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Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population
V A Essuman1, I Z Braimah, T A Ndanu
1Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana. vadessuman@yahoo.com
Insights
Combined trabeculotomy-trabeculectomy achieved a 79% success rate in Ghanaian children with primary congenital glaucoma. Success probability decreased significantly after 9 months post-surgery.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Research
Background:
- Primary congenital glaucoma is a severe form of glaucoma in infants.
- Early surgical intervention is crucial for preserving vision.
- Trabeculotomy-trabeculectomy is a surgical option for congenital glaucoma.
Purpose of the Study:
- To evaluate the surgical outcomes of combined trabeculotomy-trabeculectomy.
- To assess intraocular pressure reduction and visual field preservation.
- To identify complications in Ghanaian children with primary congenital glaucoma.
Main Methods:
- Retrospective case series of 19 eyes from 12 children.
- Primary congenital glaucoma patients undergoing trabeculotomy-trabeculectomy.
- Data collected on intraocular pressure, corneal clarity, bleb characteristics, and complications.
Main Results:
- 79% overall surgical success rate (intraocular pressure <21 mm Hg).
- Mean intraocular pressure decreased from 30.3 to 18.1 mm Hg (P<0.001).
- 90% of eyes achieved corneal clarity post-surgery; one eye developed complications.
Conclusions:
- Combined trabeculotomy-trabeculectomy is effective in Ghanaian children with primary congenital glaucoma.
- Surgical success probability declines significantly after 9 months.
- Long-term monitoring is essential to manage potential vision loss.
Purpose:
To evaluate the surgical outcome of combined trabeculotomy-trabeculectomy in Ghanaian children with primary congenital glaucoma.
Materials And Methods:
A retrospective case series involving 19 eyes of 12 consecutive children with primary congenital glaucoma who had primary trabeculotomy-trabeculectomy from 12 August 2004 to 30 June 2008, at the Korle-Bu Teaching Hospital, Ghana. Main outcome measures were preoperative and postoperative intraocular pressures, corneal diameter, corneal clarity, bleb characteristics, duration of follow-up, surgical success, and complications.
Results:
A total of 19 eyes of 12 patients met the inclusion criteria. Six of the patients were males. Mean age at diagnosis was 4.4 (range 2-8) months. Mean age at surgery was 5.9 months (range 3-16). Eight (67%) infants had bilateral disease. Mean duration of follow-up was 13.1 (range 5-38) months. The preoperative mean horizontal corneal diameter was 13.4 ± 1.1(range 12-16) mm. Complete success (intraocular pressure <21 mm Hg) was obtained in 15 (79%) eyes. The probability of success was 94.4, 83.3, 66.7, 44.4, 38.9, 33.3, and 13.3% at 3, 6, 9, 12, 15, 18, and 21 months, respectively (Kaplan-Meier analysis). All eyes had corneal oedema preoperatively. Seventeen eyes (90%) had clear cornea at their last follow-up. Mean preoperative and postoperative intraocular pressures were 30.3 ± 8.8 and 18.1 ± 6.8 mm Hg respectively (P<0.001, t-test). Twelve (63%) eyes had well-functioning blebs at the last follow-up. One eye (5%) developed seclusio pupillae and cataract postoperatively.
Conclusion:
The overall success for combined trabeculotomy-trabeculectomy in Ghanaian children with primary congenital glaucoma was 79%. The probability of success reduced from more than 66% in the first 9 months postoperatively to below 45% after that.
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