Abstract
Purpose To evaluate the safety and efficacy of a novel modified subscleral trabeculectomy technique in management of primary congenital glaucoma. Methods This study included 25 infants diagnosed of having bilateral primary congenital glaucoma. For each patient, one eye was assigned to undergo subscleral trabeculectomy with trimming of the edges of the scleral bed (group I), while the contralateral eye underwent subscleral trabeculectomy with application of mitomycin C (0.4 mg/ml for 3 min) (group II). All the patients were followed up for a period of 14 ± 3 months (range 13–22 months). Results 25 eyes were included in each group. Patients' mean age was 2.5 ± 0.5 months (range 1.8–6.5 months). The mean preoperative intraocular pressure was 31 ± 4.9 mmHg and 32.1 ± 4.0 mmHg in group I and II, respectively. The mean postoperative intraocular pressure was 9.0 ± 1.0, 11.0 ± 3.2, 12.5 ± 0.9, 13.0 ± 2.9, and 15.5 ± 1.5 mm Hg in group I and was 10.3 ± 1.2, 12.0 ± 2.5, 13.5 ± 1.7, 15.0 ± 1.5, and 17.1 ± 2.8 mm Hg in group II at the first week and 1, 3, 6, and 12 months, respectively. There was no statistically significant difference between the mean intraocular pressure values recorded at both groups preoperatively and at each follow-up visit. Failure necessitating further surgical interventions was recorded in 4 eyes (16%) in group I as compared to 3 eyes (12%) in group II (P > 0.05). Postoperative complications included mild hyphema, which occurred in one eye (4%) in group I and 2 eyes (8%) in group II, and shallow anterior chamber in 3 eyes (12%) in group I and in 2 eyes (8%) in group II. One eye (4%) in group I developed drawn-up pupil. Choroidal effusion developed in one eye (4%) at each group. Conclusion Trimming the edges of the scleral bed adjacent to the sclera flap is a safe and effective surgical step which can be added to the subscleral trabeculectomy procedure to effectively control the intraocular pressure in patients with primary congenital glaucoma, sparing them the hazards associated with mitomycin C application.
Highlights
Primary congenital glaucoma (PCG) represents diagnostic and therapeutic challenges to ophthalmologists and may lead to visual handicap [1].Subscleral trabeculectomy entails the induction of a new pathway for aqueous permeation between the anterior chamber (AC) and the subconjunctival space, beneath the scleral flap
Trabeculectomy shows a wide range of success (35% to 80%). is variability in outcome may be attributed to different factors like the patient age, associated ocular or systemic abnormalities, the use of adjuvant antimetabolites, and the variable duration of followup between different studies [3,4,5]
E mean postoperative intraocular pressure (IOP) was 9.0 ± 1.0, 11.0 ± 3.2, 12.5 ± 0.9, 13.0 ± 2.9, and 15.5 ± 1.50 mm Hg in group I and was 10.3 ± 1.2, 12.0 ± 2.5, 13.5 ± 1.7, 15.0 ± 1.5, and 17.1 ± 2.8 mm Hg in group II at the first week and 1, 3, 6, and 12 months, respectively. ese differences were statistically insignificant at each follow-up visit (P value 0.21) (Figure 2)
Summary
Subscleral trabeculectomy entails the induction of a new pathway for aqueous permeation between the anterior chamber (AC) and the subconjunctival space, beneath the scleral flap. After iridectomy and sclerectomy, the underside of the partial thickness scleral flap, the sides of the scleral wound, and the area between the episclera and conjunctiva must remain free from healing or scarring to prevent obstruction of the aqueous outflow through the fistula [2]. Trabeculectomy shows a wide range of success (35% to 80%). Halting or delaying wound healing in the early postoperative period allows steady egress of aqueous through the newly fashioned pathway and may improve the results [6]. Intraoperative modulation of wound healing, which starts just before creating the scleral wound, is of extreme significance in reducing postoperative scarring. Meticulous surgery and good tissue handling with intraoperative complete hemostasis are mandatory to minimize
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
