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Outcomes in Primary Congenital Glaucoma, 2011-2023: L V Prasad Eye Institute, Hyderabad
Anil K Mandal1, Vijaya K Gothwal2, Mohammed Hasnat Ali3
1Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India; VST Centre for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, India.
Insights
Combined trabeculotomy-trabeculectomy without mitomycin-C is an effective initial surgery for primary congenital glaucoma (PCG), especially in infantile-onset cases. Long-term success rates are encouraging, with significant intraocular pressure reduction and improved visual outcomes.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Research
Background:
- Primary congenital glaucoma (PCG) is a severe form of childhood glaucoma.
- Effective surgical management is crucial for preserving vision in PCG patients.
- Combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C (MMC) is a potential initial surgical approach.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of primary congenital glaucoma (PCG) patients treated with combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C (MMC).
- To assess the efficacy and safety of CTT without MMC as an initial surgical procedure for PCG.
- To identify factors influencing surgical success in PCG management.
Main Methods:
- Retrospective cohort study of 1128 eyes from 704 PCG patients undergoing CTT without MMC between 2011 and 2023.
- Minimum follow-up of 6 months.
- Success defined by intraocular pressure (IOP) control (≥6 to ≤16 mmHg) with or without medications, and absence of sight-threatening complications.
Main Results:
- Complete success rates at 1, 5, and 10 years were 85.9%, 69.7%, and 37.8%, respectively.
- Complete plus qualified success rates reached 98.2%, 93.3%, and 84.1% at 1, 5, and 10 years.
- Significant IOP reduction (43.4%) and improved corneal clarity were observed. Infantile-onset PCG showed better outcomes. IOP and corneal diameter were risk factors for poor outcomes.
Conclusions:
- Combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C (MMC) demonstrates encouraging long-term outcomes for primary congenital glaucoma (PCG).
- CTT without MMC can be considered a viable initial surgical option for PCG.
- Outcomes are more favorable in patients with infantile-onset PCG.
Purpose:
To report the clinical outcomes in patients with primary congenital glaucoma (PCG) managed over a period of 13 years.
Design:
Retrospective cohort study.
Participants:
One thousand one hundred fifty eyes of 704 patients undergoing surgery for PCG between January 2011 and December 2023 with a minimum follow-up of 6 months.
Methods:
Medical records of children with PCG were reviewed, and demographic and clinical data were collected. Patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C (MMC) as an initial procedure were included (n = 1128 eyes). Complete success was defined as intraocular pressure (IOP) ≥ 6 mmHg and ≤ 16 mmHg without glaucoma medications and qualified success when 1 glaucoma medication was required. Failure was defined as uncontrolled IOP with more than 1 glaucoma medication, need for repeat surgery, chronic hypotony (IOP < 6 mmHg on 2 consecutive visits at 1 month interval) or any sight-threatening complications.
Main Outcome Measures:
Intraocular pressure control, number of glaucoma medications, visual acuity (VA), and success rate.
Results:
The mean age of patients at first surgery was 23.1 (standard deviation [SD]: 44.7) months (range, 9 days to 233 months; median, 5 months) and mean follow-up was 60.1 (SD: 49.6) months. Infantile-onset PCG was the most common form (61%) of presentation. Primary CTT without MMC was performed in 1128 eyes (98.1%). Complete success rate was 85.9%, 69.7%, and 37.8%, at the 1st, 5th, and 10th year, respectively. The corresponding complete plus qualified success rate was 98.2%, 93.3%, and 84.1%, respectively. Overall, infantile-onset PCG showed better success rates than other 2 groups. There was a significant reduction in IOP at last follow-up (43.4%; P < 0.0001). Preoperatively, majority of eyes (n = 937; 81.5%) were using glaucoma medications, whereas at last follow-up, 388 eyes (41.4%) required medications (P < 0.0001). Of the 690 eyes (60%) that presented with corneal edema, 622 eyes (90%) had clear cornea at last follow-up (P < 0.0001). At last follow-up, 190 eyes (23.1%) had VA of ≥20/40. Multivariate Cox proportional hazards analysis revealed level of IOP and corneal diameter to be independent risk factors for poor surgical outcome.
Conclusions:
Our large cohort study treated by CTT without MMC is encouraging and may be considered as the initial surgical procedure in PCG. The outcomes were more favorable in children with infantile-onset PCG.
Financial Disclosure(S):
The authors have no proprietary or commercial interest in any materials discussed in this article.
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