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Published on: July 8, 2025
Surgical outcomes in children with primary congenital glaucoma: a 20-year experience
Sanaa A Yassin1, Elham R Al-Tamimi1
1Department of Ophthalmology, University of Dammam, Al-Khobar - Saudi Arabia.
Insights
Surgical outcomes for primary congenital glaucoma (PCG) show excellent intraocular pressure (IOP) control with angle surgery, particularly in infants under six months. Success rates decline over time, but medications can help.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Glaucoma Research
Background:
- Primary congenital glaucoma (PCG) is a rare, severe form of glaucoma presenting in infancy.
- Early diagnosis and intervention are crucial for preserving vision in PCG patients.
- Surgical management of PCG aims to reduce intraocular pressure (IOP) and prevent optic nerve damage.
Purpose of the Study:
- To characterize the demographic profile of patients with primary congenital glaucoma (PCG).
- To evaluate the long-term surgical outcomes of angle surgery in children with PCG over a 20-year period.
- To compare the efficacy of different angle surgical procedures for PCG.
Main Methods:
- Retrospective analysis of 148 eyes from 85 patients diagnosed with PCG.
- Surgical procedures included trabeculotomy, trabeculectomy, or combined trabeculotomy-trabeculectomy (CTT).
- Surgical success defined as IOP ≤ 21 mm Hg, with or without medication.
Main Results:
- The majority of PCG patients (78.9%) were under 6 months old, with a median age of 2 months.
- Overall surgical success rate was 80.4%, with 70.9% requiring only one surgery.
- Success rates declined progressively over time, dropping from 96.6% at 5 months to under 50% after 11 years.
Conclusions:
- Angle surgery effectively controls IOP in most PCG patients, with comparable results across trabeculotomy, trabeculectomy, and CTT.
- Infants diagnosed and treated before 6 months of age had more favorable surgical outcomes.
- Adjunctive topical antiglaucoma medications can enhance surgical success rates in PCG management.
Purpose:
To describe demographic criteria of primary congenital glaucoma (PCG) subjects and to evaluate the surgical outcomes of children who underwent angle surgery over a 20-year period.
Methods:
This is a retrospective study of patients diagnosed with PCG who underwent trabeculotomy, trabeculectomy, or combined trabeculotomy-trabeculectomy (CTT). The surgery was considered to be successful if intraocular pressure (IOP) was 21 mm Hg or less with or without treatment.
Results:
A total of 148 eyes (85 patients) were included in the study. The majority of the patients were younger than 6 months of age (78.9%), with a median age of 2 months. Sex distribution was relatively even between girls and boys (45:40) (53%/47%). Bilateral disease was seen in 63 patients (74%). The overall success rate was achieved in 80.4%. The majority of the eyes needed only one surgery (105 [70.9%]), 34 eyes (23.0%) needed 2 surgeries, and 7 eyes (4.7%) had 3 surgeries. There was no statistically significant difference in success rate between types of surgery and number of performed procedures. A progressive decline in success rate over time was evident, as success rate dropped from 96.6% at 5 months to less than 50% after 11 years of follow-up.
Conclusions:
Excellent IOP control can be achieved in a majority of patients with equally effective results from all 3 surgical procedures. The surgical outcome of PCG was more favorable in infants presenting before the age of 6 months. Adjuvant topical antiglaucoma medications can augment the surgical success rate.
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