Surgical outcome of primary developmental glaucoma: a single surgeon's long-term experience from a tertiary eye care centre in India

Eye (Lond). 2007 Jun;21(6):764-74. doi: 10.1038/sj.eye.6702324. Epub 2006 Mar 31.

Abstract

Purpose: To determine the surgical outcome after initial surgery in children with primary developmental glaucoma (PDG).

Methods: Six hundred and twenty-four eyes of 360 consecutive patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) for PDG from January 1990 to June 2004 were studied. The main outcome measures were pre- and postoperative intraocular pressures (IOPs), corneal clarity, visual acuities, refractive errors, success rate, time of surgical failure, complications, and factors associated with poor outcome.

Results: IOP reduced from 28.1+/-7.5 to 14.9+/-5.9 mmHg (P<0.0001). Probability of success (IOP<21 mmHg) was 85.2, 80.4, 77.2, 72.6, 66.2, and 57.5% at first, second, third, fourth, fifth, and sixth years, respectively (Kaplan-Meier analysis). The mean follow-up period was 20.3+/-25.6 months (median, 6 months). Preoperatively, 243 eyes (67.5%) had significant corneal oedema. Postoperatively, normal corneal transparency was achieved in 162 eyes (46.0%). Data on Snellen visual acuity were available in 100 patients (27.8%). At the final follow-up visit, 42 patients (42.0%) had normal visual acuity (>or=20/60). Myopia (mean spherical equivalent, 6.1 D) was the most common (75.0%) refractive error. In multivariate analyses, failure increased by three-fold in the presence of preoperative IOP>35 mmHg (hazards ratio (HR)=3.12; 95% confidence interval (CI), 1.4-6.7) and two-fold in cases with a history of prior glaucoma surgery (HR=2.57; 95% CI, 1.1-6.0). There were no major intraoperative complications, bleb-related infection, or endophthalmitis.

Conclusions: This series shows that prolonged IOP control can be achieved in patients with PDG and 42% of the patients gained normal visual acuity.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Anesthesia / adverse effects
  • Child
  • Child, Preschool
  • Cornea / pathology
  • Epidemiologic Methods
  • Glaucoma / complications
  • Glaucoma / physiopathology
  • Glaucoma / surgery*
  • Humans
  • India
  • Infant
  • Infant, Newborn
  • Intraocular Pressure
  • Postoperative Care / methods
  • Prognosis
  • Refractive Errors / etiology
  • Trabeculectomy* / adverse effects
  • Treatment Outcome
  • Visual Acuity