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Combined trabeculotomy-trabeculectomy for primary congenital glaucoma: long-term experience from a tertiary referral
Anil K Mandal1, Vijaya K Gothwal2, Rohit Khanna3
1Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India.
Insights
Combined trabeculotomy-trabeculectomy (CTT) is a safe and effective surgical option for primary congenital glaucoma (PCG). This procedure offers long-term intraocular pressure (IOP) control and visual benefits for affected children.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Research
Background:
- Primary congenital glaucoma (PCG) is a rare, severe form of glaucoma presenting in infancy.
- Effective long-term management of PCG is crucial to prevent irreversible vision loss.
- Surgical intervention is the primary treatment for PCG to reduce intraocular pressure (IOP).
Purpose of the Study:
- To evaluate the long-term surgical and visual outcomes of combined trabeculotomy-trabeculectomy (CTT) in patients with PCG.
- To identify risk factors associated with poor surgical outcomes in PCG.
- To assess the safety and efficacy of CTT as a primary surgical procedure for PCG.
Main Methods:
- Retrospective review of medical records for 653 PCG patients (1128 eyes) who underwent CTT without mitomycin-C.
- Success defined as IOP <16 mmHg with or without one glaucoma medication.
- Kaplan-Meier survival analysis and multivariate analysis were used to assess outcomes and risk factors.
Main Results:
- Long-term complete success rates at 1, 5, 10, 15, and 19 years were 92.6%, 75.5%, 55.9%, 44.7%, and 21.6%, respectively.
- Independent risk factors for failure included preoperative corneal clarity and prior glaucoma surgery.
- At last follow-up, 22% of patients had good visual acuity (≥6/12), while 37% were blind; no serious complications were noted.
Conclusions:
- Primary CTT is a safe and effective surgical procedure for controlling IOP in PCG patients.
- CTT offers significant long-term benefits for visual function in a substantial proportion of PCG patients.
- Careful patient selection and management of risk factors can optimize surgical outcomes in PCG.
Purpose:
To evaluate the long-term visual and surgical outcomes, and associated risk factors for poor outcomes in patients with primary congenital glaucoma (PCG).
Methods:
Retrospective review of medical records of children who underwent combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C as the first surgical procedure by a single surgeon between January 1990 and December 2010. Success was defined as intraocular pressure (IOP) <16 mmHg without (complete) or with (qualified) one glaucoma medication. We used the WHO criteria of vision loss to categorize the levels of vision impairment (VI). For purposes of statistical analysis, we randomly chose one eye of patients for bilateral PCG and affected eye in unilateral PCG.
Results:
The cohort included 653 consecutive PCG patients (1128 eyes; mean age, 26 months), of whom 475 (73%) underwent simultaneous bilateral CTT. Kaplan-Meier survival analysis revealed 1-, 5-, 10-, 15-, and 19-year complete success rates of 92.6% (n = 372), 75.5% (n = 173), 55.9% (n = 72), 44.7% (n = 19), and 21.6% (n = 3), respectively. Multivariate analysis revealed independent associations between failure, preoperative corneal clarity, and prior glaucoma surgery. Mean follow-up was 41 ± 51 months (range, 6 months to 19 years; median, 1 year). Of the visual acuity (VA) data in the affected eyes obtained at last follow-up (n = 333, 51%), seventy-four patients (22%) had VA of ≥6/12. Of the remaining 259 patients, 18 (7%) had mild VI, 87 (34%) had moderate VI, 58 (22%) had severe VI, and 96 (37%) were blind. No serious complications were noted.
Conclusions:
Primary CTT may be safely employed to control IOP and may provide long-term benefits in PCG patients.
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