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

Surgical interventions for primary congenital glaucoma

“…We defined surgical success as IOP less than or equal to 21 mm Hg with or without glaucoma medications after one glaucoma surgery. We adopted this definition somewhat arbitrarily based on the definitions of surgical success in the literature, including nonrandomized studies (Al-Hazmi 2005; Zhang 2009). …”

“…Zhang 2009 is a retrospective study from China comparing different glaucoma procedures in children with PCG. The groups were not equivalent.…”

“…Of the 148 combined surgery cases studied, 1% were classified as mild (100% success rate), 47% were classified as moderate (80% success rate) and 51% were classified as severe (70% success rate). Zhang 2009 was a retrospective study in China. Trabeculotomy was the primary preferred procedure, the combined procedure with MMC was performed in glaucomas deemed severe (age > three years, corneal diameter > 14 mm) by the study investigators if the cornea was clear and the edema was mild.…”

Childhood glaucoma surgery in the 21st Century

“…Evidence is sparse but it suggests the impact of childhood glaucoma is significant throughout the child's life both at home and school. 137 Furthermore, the emotional and psychological burden of caregivers of patients with childhood glaucoma is thought to be considerable. 138 Recognition of the importance of the measuring the impact of illness, disability, and treatment from the patient's perspective has resulted in development and evaluation of Patient-Reported Outcome Measures and Patient-Reported Experience Measures for use within paediatric ophthalmology.…”

Konjenital Glokomlu Olgularda Viskotrabekülotomi ve Klasik Trabekülotomi Cerrahisinin Uzun Dönem Karşılaştırmalı Sonuçları

“…[2][3][4][5][6][7] Besides the conventional procedures which include goniotomy, trabeculotomy ab externo and trabeculectomy, many new surgical procedures have been developed as safer a nd probably more efficacious alternatives. [8][9][10][11][12] With the advent of viscoelastic materials, Tamcelik have previously described the viscotrabeculotomy technique which incorporates viscodissection and viscodilation procedures to the conventional trabeculotomy. The results of this technique in comparison with conventional trabeculotomy during a mean follow-up period of 60 months have been previously published.…”