Time of diagnosis, reoperations and long-term results of goniotomy in the treatment of primary congenital glaucoma: a clinical study

Abstract

Purpose: The aim of our study was to get information about the development of visual acuity, visual field and cup-disc ratio of patients with primary congenital glaucoma after IOP-regulating goniotomy by means of a katamnestic inquiry. The preoperative conditions of IOP, corneal diameter and corneal opacity were related to postoperative findings of visual acuity, visual field and cup-disc ratio reported by the treating ophthalmologists.

Methods: 196 patients were contacted, who had a goniotomy in the period from 1965 to 1983 at the University Eye Hospital Würzburg. Out of the 92 returned replies, the address of the treating ophthalmologists could be ascertained from 77 patients. Sixty of the 77 patients fulfilled the inclusion criteria: (1) primary congenital glaucoma and (2) IOP-regulating goniotomy as last surgery.

Results: I. In 76% of 106 eyes childhood glaucoma was diagnosed during the first year of life. II. In 72% of 60 eyes/patients with primary congenital glaucoma one goniotomy was sufficient to reach a normal IOP. In 18% a second and in 10% a third goniotomy was necessary, but without influence on the visual outcome. III. Even in the groups of eyes with a preoperative IOP of more than 40 mmHg, preoperative corneal diameter of more than 13 mm and preoperative severe corneal opacity more than 50% reached a visual acuity of 0.4-1.2 and more than 80% had a normal visual field. Only 9% of the eyes showed a cup-disc ratio of 0.6 or more.

Conclusions: In primary congenital glaucoma even eyes with high preoperative IOP, large corneal diameters and severe corneal edemas had a good prognosis of visual outcome after goniotomy.