[Trabeculectomy in congenital glaucoma: retrospective medium and long-term results]

We present a retrospective analysis of medium and long-term results of trabeculectomy we have performed in our department as a first surgical procedure in patients with congenital glaucoma between 1976 and 1995.

Our study included 26 patients (46 eyes)(ratio M/F = 18/8) with congenital (< or = 2 months = 4 patients including 3 glaucoma present at birth), infantile (> 2 months, < or = 24 months = 18 patients) and juvenile glaucoma (> 24 months and < or = 25 years). In 42 eyes, we performed a trabeculectomy as a first surgical procedure. A trabeculectomy was combined peroperatively with a trabeculotomy in one eye and a trabeculectomy was associated with antimetabolites in 3 eyes. The trabeculodysgenesis was isolated in 38 eyes and was associated with a dysgenesis of the anterior segment in 4 eyes and a Sturge Weber syndrome in 4 other cases. The mean actual follow-up is 88.8 +/- 87.8 months (3 to 304 months) and is presently longer than 15 years in 6 patients. The mean age at the time of surgery was 24.4 months and was reduced to 4.9 months when we excluded the 4 patients with a juvenile glaucoma. An early postoperative objective refraction was performed in all patients. Correcting lenses were prescribed and associated with occlusion if needed. Beside tonometric, ophthalmoscopic and biometric monitoring, we investigated patient's final visual acuity, objective refraction, binocular vision, visual field when possible as well as their educational orientation.

The mean 3 months (16.6 +/- 6.2 mm Hg), 12 months (16.1 +/- 6.9 mm Hg) and the mean final IOP (15.3 +/- 6.5 mm Hg) was significantly reduced compared with preoperative IOP (30.3 +/- 8.3 mm Hg). In the last exam, IOP was < or = 16 mm Hg in 33 eyes (71.7%) and < or = 20 mm Hg in 41 eyes (89.1%). Among significant postoperative complications, we observed 2 uveal effusion syndromes. The regression of the optic disc cupping was significant at every control by comparison with its preoperative evaluation. A medical adjunctive treatment was mandatory in 20 eyes. Our 5 failures concerned eyes with multiple surgical procedures. We had to perform one or more additional surgical procedures in 16 eyes (34.7%), knowing that neonatal forms and high myopic eyes have needed more additional surgical procedures. The mean period between different additional surgeries was varying in large amounts (mean period = 32 +/- 82 months). A filtration bleb was visible at the last examination in a minority of patients (n = 11 eyes). Final mean visual acuity was 0.5 +/- 0.4 (n = 35) and was > 0.8 in 10 eyes of the 14 (7 patients) with an actual follow-up longer than 120 months.

In our experience, trabeculectomy may be considered as a valid and relatively safe first choice procedure in the treatment of congenital glaucoma, although requiring a frequent adjunctive medical treatment and a relatively high incidence of additional surgical procedures. The large induced IOP reduction allows to maintain an excellent visual potential in combination with orthoptic treatment in a very significant number of cases.