Surgical results of combined trabeculotomy-trabeculectomy for developmental glaucoma

Abstract

Objective The purpose of the study was to evaluate the surgical outcome of combined trabeculotomy-trabeculectomy in different types of primary developmental glaucomas. Design A retrospective review of all cases of primary developmental glaucomas that underwent primary combined trabeculotomy-trabeculectomy between August 1990 and September 1995, with a minimum follow-up of 6 months, was performed. Participants One hundred and eighty-two eyes of 120 patients were included in this study; 122 (67%) eyes had congenital glaucoma; 22 (12.1%) eyes had infantile glaucoma; and 38 (20.9%) eyes had juvenile glaucoma. Intervention Primary combined trabeculotomy-trabeculectomy was the chosen intervention. Main outcome measures Preoperative and postoperative intraocular pressures, visual acuities, success rate, corneal clarity and diameters, bleb characteristics, time of surgical failure, and complications were the main outcome measures. Results Intraocular pressure (mean ± SD) reduced from a preoperative level of 26.5 ± 8.3 mmHg; 30.3 ± 9.9 mmHg; and 31.8 ± 11.5 mmHg to 13.1 ± 5.8 mmHg; 13.7 ± 4.4 mmHg; and 13.3 ± 6.0 mmHg in the congenital, infantile, and juvenile types of developmental glaucomas, respectively. Kaplan-Meier survival analysis showed that the success probability at 6 months was 94.4% ± 2.3%; 90.9% ± 6.1%; and 81.0% ± 7.3% in the three groups, respectively. The success probability of patients with juvenile glaucoma was significantly lower than it was for those with congenital glaucoma ( P = 0.0393). Of 182 eyes, 105 (57.7%) eyes had corneal edema at presentation. Eighty-one (79%) of 105 eyes had complete clearance of corneal edema postoperatively ( P < 0.0001). The follow-up period ranged from 6 months to 48 months (mean, 10.7 ± 12.0 months). There were no sight-threatening intraoperative and postoperative complications in any patient. Conclusions Primary combined trabeculotomy-trabeculectomy is safe, effective, and sufficiently predictable to be considered the first choice of surgical treatment in primary congenital glaucoma with corneal edema. Juvenile glaucoma has the worst prognosis, and infantile glaucoma has a better prognosis than does juvenile glaucoma.