Outcomes of Surgical Interventions in Primary Congenital Glaucoma Patients

Abstract

Purpose: The aim was to report long-term surgical success of primary congenital glaucoma (PCG) patients in Thailand. Materials and Methods: PCG patients who underwent one of the following primary operations: trabeculotomy, goniotomy, trabeculectomy, combined trabeculotrabeculectomy (CTT) and diode transscleral cyclophotocoagulation (TSCPC) between January 1992 and January 2018 were reviewed. Surgical success was defined as intraocular pressure (IOP) between 5 and 21 mm Hg with or without antiglaucoma medications. Failure was defined as IOP ≤5 or ≥21 mm Hg for 2 consecutive visits, or when an additional glaucoma surgery was required to control IOP. Survival curves were analyzed using multilevel mixed-effect Weibull model. Results: A total of 81 eyes from 55 PCG patients were included. Surgical procedures involved 20 goniotomies, 15 trabeculotomies, 16 trabeculectomies, 15 CTT, and 15 TSCPC. Median follow-up time was 24 months (interquartile range: 9 to 60 mo). Overall success rates were 68.8% at 1 year, 63.8% at 3 years, and 53.7% at 5 years. All types of surgery except TSCPC had comparable cumulative 1 year success rates ranging from 78.5% to 83.3%. Cumulative success rates of trabeculotomy (80.05%) and CTT (79.4%) were maintained at 3 and 5 years and were the highest among all procedures at 5 years. TSCPC had a significantly lower success rate compared with other types of surgery (hazard ratio: 7.4 to 13.1, all P=0.01). All patients receiving primary TSCPC showed no success at 48 months. Conclusion: Primary trabeculotomy and primary CTT demonstrated the highest long-term success rates in PCG patients.

Long-Term Results of Combined Trabeculotomy Trabeculectomy in Primary Congenital Glaucoma

“…A recent report from Thailand assessed the long-term surgical success of various techniques in PCG. In this study, Suvannachart et al 22 concluded that primary trabeculotomy and primary CTT had the highest long-term success rates in PCG patients (81 eyes from 55 PCG patients, 5-year follow-up). Except for the pending results of a multicenter randomized controlled trial conducted by Fang et al, 29 we are unaware of any published studies comparing long-term results of CTT compared with trabeculotomy in the same target population with PCG…”

“…4,6,[12][13][14][15][16][17][18][19][20][21] In Thailand, a recent study comparing various techniques including trabeculotomy, goniotomy, trabeculectomy, and CTT concluded that primary trabeculotomy and primary CTT had the highest long-term success rates in PCG patients. 22 As the optimum first-line approach is still the subject of considerable debate in Tunisia and North African countries, we conducted this study to assess 10-year outcomes as well as factors influencing the surgical success of CTT in children with PCG in a North African pediatric population.…”

“…In addition, this practice has proven to be safe and effective in several studies 4,6,12–21 . In Thailand, a recent study comparing various techniques including trabeculotomy, goniotomy, trabeculectomy, and CTT concluded that primary trabeculotomy and primary CTT had the highest long-term success rates in PCG patients 22 …”

Comparison between ocular biometry parameters in patients with unilateral congenital glaucoma

“…[ 28 ] and Suvannachart et al . [ 29 ] in their study. We prefer not to use MMC during the primary procedure due to the risk of hypotony in the early postoperative period and bleb related complications in the long run.…”

“…[ 28 ] and 79.4% reported by Suvannachart et al . [ 29 ] The probable reason for the high success rate could be the use of MMC by Zhang et al . [ 28 ] and Suvannachart et al .…”