Long-term surgical outcomes of primary congenital glaucoma in China

Abstract

Objective: To evaluate the long-term outcomes of three surgical procedures for the treatment of primary congenital glaucoma (PCG).

Introduction: PCG is one of the main causes of blindness in children. There is a paucity of contemporary data on PCG in China.

Methods: A retrospective study of 48 patients (81 eyes) with PCG who underwent primary trabeculectomy, trabeculotomy, or combined trabeculotomy and trabeculectomy (CTT).

Results: All patients were less than 4 years (yrs) of age, with a mean age of 2.08 +/- 1.23 yrs. The mean duration of follow-up was 5.49 +/- 3.09 yrs. The difference in success rates among the three surgical procedures at 1, 3, 6 and 9 yrs was not statistically significant (p = 0.492). However, in patients with over 4 yrs of follow-up, Kaplan-Meier survival analysis revealed that the success rates of trabeculectomy and CTT declined more slowly than that of trabeculotomy. Among the patients, 66.22% acquired good vision (VA > 0.4), 17.57% acquired fair vision (VA = 0.1 - 0.3), and 16.22% acquired poor vision (VA < 0.1). The patients with good vision were mostly in the successful surgery group. Myopia was more prevalent postoperatively (p = 0.009). Reductions in the cup-disc ratio and corneal diameter were only seen in the successful surgery group (p = 0.000). In addition, the successful surgery group contained more patients that complied with a regular follow-up routine (p = 0.002).

Discussion: Our cases were all primary surgeries. Primary trabeculectomy was performed in many cases because no treatment was sought until an advanced stage of disease had been reached.

Conclusions: In contrast to most reports, in the present study, trabeculectomy and CTT achieved higher long-term success rates than trabeculotomy. The patients with successful surgical results had better vision. Compliance with a routine of regular follow-up may increase the chances of a successful surgical outcome.

Keywords: China; Combined trabeculotomy and trabeculectomy (CTT); Primary congenital glaucoma (PCG); Trabeculectomy; Trabeculotomy.

Figure 1 -

Kaplan–Meier survival curve (for eyes with over 4 yrs of follow-up). The cumulative success rates of three surgical techniques for the eyes of PCG patients with over 4 yrs of follow-up were evaluated by Kaplan-Meier survival analysis. The success rates declined over time, with that of CTT declining the most slowly, followed by trabeculectomy, and trabeculotomy, which demonstrated the fastest decrease. The differences between them were statistically significant according to the Log-Rank test (χ² = 7.651, p = 0.022). This indicates that long-term follow-up (≥ 4 yrs) was a superior metric for surgical outcome. Compared with trabeculotomy, trabeculectomy and CTT achieved better long-term surgical outcomes. PCG, primary congenital glaucoma; CTT, combined trabeculotomy and trabeculectomy.