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Abstract #10407 Published in IGR 6-1
Long-term surgical and visual outcomes in Indian children with developmental glaucoma operated on within six months of birth
Mandal AK; Bhatia PG; Bhaskar A; Nutheti ROphthalmology 2004; 111: 283-290
PURPOSE: To determine the long-term surgical and visual outcomes in Indian children with developmental glaucoma operated within six months of birth. DESIGN: Retrospective consecutive, noncomparative case series. PARTICIPANTS: All children with developmental glaucoma who underwent surgery within six months of birth over a 12-year period were included. METHODS: Two hundred and ninety-nine eyes of 157 consecutive patients who underwent primary combined trabeculotomy-trabeculectomy for developmental glaucoma from January 1990 through December 2001 by a single surgeon were studied. However, for the purpose of statistical analysis, only one randomly chosen eye of patients with a bilateral affliction (142, 90.4%) was considered. MAIN OUTCOME MEASURES: The main outcome measures were preoperative and postoperative intraocular pressure (IOP), corneal clarity and diameters, visual acuities, refractive errors, success rate, time of surgical failure, and complications. RESULTS: The series consisted of 299 primary combined trabeculotomy-trabeculectomy surgeries during 157 anesthesias. The IOP was reduced from 26.6 ± 6.2 mmHg to 14.4 ± 4.9 mmHg, with a mean percentage reduction of 41.1 ± 28.8 (p < 0.0001). The probability of success (IOP < 21 mmHg) was 94.4, 92.1, 86.7, 79.4, 72.9, and 63.1% at the first, second, third, fourth, fifth, and sixth year, respectively (Kaplan-Meier analysis). The mean follow-up period was 26.5 ± 25.1 months. Preoperatively, 133 eyes (84.7%) had significant corneal edema. Postoperatively, normal corneal clarity was achieved in 83 of 133 eyes (62.4%) with corneal edema. There were no major intraoperative complications. Postoperatively, 17 eyes (10.8%) had a shallow anterior chamber develop; three of these (17.6%) required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Data on visual acuity were available in 49 patients (31.2%). At the final follow-up visit, 20 patients (40.8%) had normal visual acuity (best-corrected visual acuity of ≥ 20/60 in the better eye). CONCLUSIONS: Primary combined trabeculotomy-trabeculectomy is safe and effective for developmental glaucoma when performed within six months of birth. It leads to excellent IOP control and moderate visual outcome.
Dr. A.K. Mandal, Jasti V. Ramanamma Children's Eye Care Centre, L. V. Prasad Eye Institute, Hyderabad, India. mandal@lvpei.org
Classification:
9.1 Developmental glaucomas (Part of: 9 Clinical forms of glaucomas)
12.1 General management, indication (Part of: 12 Surgical treatment)
