Long-term Results of Combined Trabeculotomy-Trabeculectomy in Primary Congenital Glaucoma from a Tertiary Eye Care Center in Tunisia

Abstract

Objective: To report the long term visual and surgical outcomes of combined trabeculotomy trabeculectomy (CTT) as the initial glaucoma surgery in children with primary congenital glaucoma (PCG). Methods: Prospective analysis of children who underwent primary CTT for PCG between January 2010 and December 2019. The main outcome measures were intraocular pressure (IOP) reduction, corneal clarity, success rate, complications, refractive errors and visual acuities (VA). Results: A total of 98 eyes of 62 patients were enrolled. At last follow up, mean IOP reduced from 22.68 mmHg to 9.75 mmHg (P<0.0001). Complete success rate was 91.6%, 88.4%, 84.7%, 71.6%, 59.7%, and 54.3%, respectively at first, second, fourth, sixth, eighth, and tenth year. Follow-up averaged 42.06 months. Preoperatively, 72 eyes (73.5%) had significant corneal haze, 84.7% among them achieved normal corneal transparency. Among the sight threatening complications, endophthalmitis was encountered in one eye. Myopia was the most common refractive error (80.6%). Data on Snellen VA were available for 53.2% of the patients. 33.3% of patients achieved normal VA (VA above 6/12), 21.2% had mild visual impairment (VI), 9.1% had moderate VI, 21.2% had severe VI, and 15.2% were blind. The failure rate was statistically correlated to the early disease onset (<3 months) and to preoperative corneal clouding (p=0.022 and p=0.037, respectively). Two critical time points were identified: within the first year and around the sixth year (28.6 and 25% of surgical failures, respectively). Conclusion: Primary CTT seems to be an optimal procedure in a population with advanced disease at presentation, problematic follow ups, and limited resources.