Long-term Results of Combined Trabeculotomy-Trabeculectomy in Primary Congenital Glaucoma.

Abstract

Primary congenital glaucoma in Tunisian children seems to be characterized by a high prevalence of inherited and advanced form of the disease. Primary combined trabeculotomy-trabeculectomy allowed satisfactory long-term IOP control and reasonable visual outcome. To report the long-term outcome of combined trabeculotomy-trabeculectomy (CTT) as the initial glaucoma surgery in children with primary congenital glaucoma (PCG). Retrospective analysis of children who underwent primary CTT for PCG between January 2010 and December 2019. The main outcome measures were intraocular pressure (IOP) reduction, corneal clarity, complications, refractive errors and visual acuity (VA). Success was defined as IOP <16mmHg without (complete) or with (qualified) antiglaucoma medication. The WHO criteria of vision loss were used to categorize vision impairment (VI). 98 eyes of 62 patients were enrolled. At last follow-up, mean IOP was reduced from 22.7±4.0mmHg to 9.7±3.9mmHg (P<0.0001). Complete success rate was 91.6%, 88.4%, 84.7%, 71.6%, 59.7%, and 54.3%, at the first, second, fourth, sixth, eighth, and tenth year, respectively. Follow-up averaged 42.1±28.4 months. Preoperatively, 72 eyes (73.5%) had significant corneal edema versus 11 eyes (11.2%) at the end of the follow-up (P<0.0001). Endophthalmitis was encountered in one eye. Myopia was the most common refractive error (80.6%). Data on Snellen VA were available for 53.2% of the patients; 33.3% achieved a VA ≥ 6/12, 21.2% had mild VI, 9.1% had moderate VI, 21.2% had severe VI, and 15.2% were blind. The failure rate was statistically correlated to the early disease onset (<3mo) and to preoperative corneal edema (P=0.022 and P=0.037, respectively). Primary CTT seems to be a good procedure in a population with advanced PCG at presentation, problematic follow-up visits, and limited resources.