Surgical management of primary congenital glaucoma in egypt

Abstract

Purpose To study primary congenital glaucoma characteristics and surgery in a University-based practice in Egypt. Patients and methods The present study was a retrospective chart review of 165 eyes of 112 children who presented and were operated upon between 2005 and 2012 at Alexandria Main University Hospital in Egypt. The charts were reviewed for demographics as well as clinical data. Postoperative data were retrieved till the end of the follow-up period. Complications were noted, and success rates were studied. Results The mean age±SD (range) of the study population at presentation was 6.1±4.4 (1–24) months, and of the follow-up period was 32.3±21.7 (6–78) months. The average (range) number of glaucoma procedures performed for each eye was 1.3 (1–4). The most common primary glaucoma surgical procedure performed was combined trabeculotomy–trabeculectomy with mitomycin C (143 procedures). The mean values (range) of preoperative intraocular pressure (on no intraocular pressure lowering therapy), corneal diameter and thickness, cup/disc ratio and axial length of the study eyes were 18.7±5.9 (5–36) mmHg, 12.8±0.9 (10–17) mm and 619.5±95.2 (433–784) μm, 0.6±0.2 (0–1) and 22.99±1.82 (17.0–30.59) mm, respectively, and postoperatively at last follow-up were 7.4±6.6 (0–46) mmHg, 13.0±0.9 (10–18) mm and 530.6±75.1 (425–823) μm, 0.3±0.3 (0–1) and 24.06±2.13 (20.55–30.75) mm, respectively. Cumulative success by Kaplan–Meier analysis was 0.97, 0.89, 0.83, 0.73 and 0.61 at 1, 2, 3, 4 and 5 years, respectively. Complications included corneal scarring, cataract, intraretinal haemorrhages, hypotony disc oedema, rhegmatogenous retinal detachment and endophthalmitis. Conclusion Combined trabeculotomy–trabeculectomy with mitomycin C is a successful treatment for primary congenital glaucoma. Meticulous, continuous and prolonged follow-up is mandatory for all operated cases to ensure long-term success.