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Long-Term Surgical Outcomes of Primary Congenital Glaucoma in a South Indian Population
Menaka Vimalanathan1, Prakrati Gupta2, S Ashok Vardhan2
1Department of Glaucoma, Aravind Eye Hospital Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India.
Insights
Long-term surgical success for primary congenital glaucoma (PCG) in children is low, declining significantly over time. Lifelong monitoring is crucial for managing PCG to prevent vision loss.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Glaucoma Research
Background:
- Primary congenital glaucoma (PCG) is a severe form of childhood glaucoma.
- Effective long-term management strategies for PCG are critical to prevent irreversible vision loss.
Purpose of the Study:
- To evaluate the long-term surgical outcomes in a South Indian pediatric population with primary congenital glaucoma (PCG).
Main Methods:
- This retrospective cohort study analyzed data from children with PCG who underwent primary glaucoma surgery between 1997 and 2000.
- Survival analyses were used to determine the cumulative probability of surgical success over a minimum of 5 years of follow-up.
Main Results:
- Mean intraocular pressure (IOP) significantly decreased post-surgery (28.58 to 17.13 mmHg).
- The probability of surgical success for combined trabeculotomy and trabeculectomy (CTT) declined from 77.8% at 1 year to 16.6% at 15 years.
- Long-term surgical success rates were low, and visual acuity correlated with surgical outcomes.
Conclusions:
- Surgical success in children with PCG is limited in the long term.
- The probability of maintaining surgical success diminishes over time, necessitating lifelong patient follow-up.
- Continuous management is essential for children with PCG to prevent visual impairment and blindness.
Purpose:
To evaluate the long-term surgical outcomes of children with primary congenital glaucoma (PCG) in a South Indian population.
Design:
Retrospective cohort study.
Participants:
Children with PCG who underwent primary surgery from 1997 through 2000 at a tertiary eye center in India with minimum of 5 years of follow-up.
Methods:
This retrospective cohort study included children with PCG who underwent trabeculotomy, trabeculectomy, or combined trabeculotomy and trabeculectomy (CTT) as primary surgery from 1997 through 2000 at a tertiary eye center in India with minimum of 5 years of follow-up. Survival analyses were performed to determine cumulative probability of complete and qualified success.
Main Outcome Measures:
Intraocular pressure (IOP) control, glaucoma medication use, surgical success rates, and complications.
Results:
The study included 50 eyes of 31 patients. Mean age at initial surgery was 5 months (range, 5 days-48 months) and 19 patients (61.3%) showed bilateral disease. Mean duration of follow-up was 10.9 ± 3.10 years (range, 6-18 years). Mean IOP was reduced from 28.58 ± 9.78 mmHg (range, 10-59 mmHg) before surgery to 17.13 ± 7.62 mmHg after surgery (range, 5-42 mmHg; P < 0.001) at final follow-up. Survival analysis showed that the probability of surgical success with CTT was 77.8% at 1 year, 66.2% at 2 years, 53.0% at 5 years, and 16.6% at 15 years. Visual acuity at last available follow-up correlated with surgical success (P = 0.042).
Conclusions:
Surgical success after long-term follow-up of children with PCG is low. The probability of surgical success declines over time. Children with PCG require life-long follow-up and management, even after initial surgical success, to prevent visual impairment and blindness.
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