Excision of Tenon Capsule in Pediatric Trabeculectomy: A Controlled Study

Abstract

Purpose: To compare the results of trabeculectomy alone and combined with partial tenonectomy in pediatric glaucoma patients.

Methods: This was a prospective, controlled, cohort study that included 64 eyes of 46 children younger than 12 years with uncontrolled glaucoma, who underwent trabeculectomy with mitomycin C in an institutional setting. Patients were randomized to undergo a trabeculectomy either with (group A) or without (group B) tenonectomy. Children were followed up prospectively for 24 months. Kaplan-Meier survival analysis and mean survival times with 95% confidence intervals (CIs) were calculated. Postoperative results were compared at 3, 6, 12, and 24 months of follow-up. The main outcome measures were: intraocular pressure (IOP), surgical success, postoperative interventions, and complications in both groups.

Results: Mean postoperative IOP was lower in group A at all postoperative visits (19.2 mm Hg in group A vs. 22.1 mm Hg in group B at 24 mo, P=0.05). There was a tendency toward greater use of glaucoma medications in group B (P<0.001). Cumulative probability of survival at 24 months was 70% (95% CI, 48%-86%) for group A, and 45% (95% CI, 28%-63%) for group B (P=0.09). Mean survival time was significantly longer (P=0.04) in group A (16.6 mo) than in group B (11.6 mo). Encapsulation occurred more frequently (P=0.03) in group B (25%) than in group A (3%).

Conclusions: Excision of the Tenon capsule could help achieve better IOP control in pediatric glaucoma surgery.