Long-term surgical and visual outcomes in Indian children with developmental glaucoma operated on within 6 months of birth

Abstract

Purpose: To determine the long-term surgical and visual outcomes in Indian children with developmental glaucoma operated within 6 months of birth.

Design: Retrospective consecutive, noncomparative case series.

Participants: All children with developmental glaucoma who underwent surgery within 6 months of birth over a 12-year period were included.

Methods: Two hundred ninety-nine eyes of 157 consecutive patients who underwent primary combined trabeculotomy-trabeculectomy for developmental glaucoma from January 1990 through December 2001 by a single surgeon were studied. However, for the purpose of statistical analysis, only 1 randomly chosen eye of patients with a bilateral affliction (142, 90.4%) was considered.

Main outcome measures: The main outcome measures were preoperative and postoperative intraocular pressures (IOPs), corneal clarity and diameters, visual acuities, refractive errors, success rate, time of surgical failure, and complications.

Results: The series consisted of 299 primary combined trabeculotomy-trabeculectomy surgeries during 157 anesthesias. The intraocular pressure was reduced from 26.6+/-6.2 mmHg to 14.4+/-4.9 mmHg, with a mean percentage reduction of 41.1+/-28.8 (P<0.0001). The probability of success (IOP<21 mmHg) was 94.4%, 92.1%, 86.7%, 79.4%, 72.9%, and 63.1% at first, second, third, fourth, fifth, and sixth year, respectively (Kaplan-Meier analysis). The mean follow-up period was 26.5+/-25.1 months. Preoperatively, 133 eyes (84.7%) had significant corneal edema. Postoperatively, normal corneal clarity was achieved in 83 of 133 eyes (62.4%) with corneal edema. There were no major intraoperative complications. Postoperatively, 17 eyes (10.8%) had a shallow anterior chamber develop; 3 of these eyes (17.6%) required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Data on visual acuity were available in 49 patients (31.2%). At the final follow-up visit, 20 patients (40.8%) had normal visual acuity (best-corrected visual acuity of >/=20/60 in the better eye).

Conclusions: Primary combined trabeculotomy-trabeculectomy is safe and effective for developmental glaucoma when performed within 6 months of birth. It leads to excellent IOP control and moderate visual outcome.