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Abstract #8028 Published in IGR 4-3
Safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma
Mandal AK; Bhatia PG; Gothwal VK; Reddy VM; Sriramulu P; Prasad MS; John RK; Nutheti R; Shamanna BRIndian Journal of Ophthalmology 2002; 50: 13-19
PURPOSE: To establish the safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma. METHODS: The authors studied 109 consecutive patients who underwent planned simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma by a single surgeon from January 1990 to December 1999. The main outcome measures were postoperative intraocular pressure (IOP), corneal clarity and diameter, visual acuity, bleb characteristics, time of surgical failure and complications. Postoperative complications including endophthalmitis and anesthetic morbidity and mortality were also analyzed. RESULTS: The series consisted of 218 primary combined trabeculotomy-trabeculectomy surgeries during 109 anesthesias. The mean follow-up period was 16.33 ± 16.22 months. The IOP reduced from 26.4 ± 5.9 mmHg to 13.5 ± 4.5 mmHg, with a mean percentage reduction of 46.2 ± 23.7 (p < 0.0001). The success (IOP < 16 mmHg) probabilities were 90.9, 88.0, and 69.3% at first, second and third year, respectively (Kaplan-Meier analysis). The success probability of 69.3% obtained at third year was maintained until six years of follow-up. One hundred and sixty-six (76.1%) eyes had significant corneal edema. Postoperatively, the cornea cleared in 93 (57.8%) eyes. Clinically, well functioning blebs were present in 114 of 171 eyes (66.6%). Postoperatively, 18 (8.3%) eyes developed shallow anterior chamber and six (33.3%) of these required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Of the anesthetic complications, apnea occurred in 17 (15.6%) patients and all were successfully resuscitated. The most serious post-anesthetic complication was cardio-pulmonary arrest that occurred five hours postoperatively following aspiration during feeding in one child; this child could not be resuscitated. Two children had delayed recovery (two and four hours, respectively). The child who had delayed recovery by two hours survived and has completed three years of follow-up, while the other child died 48 hours later. CONCLUSIONS: Simultaneous bilateral primary combined trabeculotomy-trabeculectomy is safe and effective for developmental glaucoma. It obviates the need for long second anesthesia with its attendant risks. It offers several other benefits to the patients and families.
A.K. Mandal, MD, Jasti V Ramanamma Childrens' Eye Care Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad 500 034, India. mandal@lvpeye.stph.net
Classification:
12.9 Trabeculotomy, goniotomy (Part of: 12 Surgical treatment)
