Primary Combined Trabeculotomy-Trabeculectomy for Developmental Glaucomas

Mandal, Anil K.; Chakrabarti, Debasis

doi:10.5005/jp-journals-10008-1076

Cited by 16 publications

(36 citation statements)

References 9 publications

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“…20,21 The most compelling argument favoring primary CTT in early-onset glaucoma in ARA was the higher incidence of successful IOP control with a single operative procedure as has been already reported by us. [12][13][14][15][16][17][18] The aim of the present study as to evaluate the surgical outcome of infants with secondary glaucoma associated with ARA. Kaplan-Meier survival analysis demonstrated the probability of complete success of 93% till 5 years, and then 88.1%, 82.3%, 70.5%, 56.4%, and 42.3% at year 6, 7, 8, 9, and 10, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…He advocated trabeculectomy possibly with antimetabolites in this situation. 1 Mandal et al [10][11][12][13][14][15][16][17][18] reported combined trabeculotomy-trabeculectomy (CTT) as a successful surgical procedure in primary developmental glaucoma as well as early-onset glaucoma in Sturge-Weber syndrome. The aim of the present study was to evaluate our surgical results in early-onset glaucoma in ARA.…”

Section: Introductionmentioning

confidence: 99%

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Early-onset glaucoma in Axenfeld–Rieger anomaly: long-term surgical results and visual outcome

Mandal

Pehere²

2016

Eye

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Purpose To determine the long-term surgical and visual outcomes in Indian children with early-onset glaucoma associated with Axenfeld-Rieger anomaly (ARA). Methods This is a retrospective analysis of 44 eyes of 24 consecutive children with early-onset glaucoma (within 3 years of age) and ARA who underwent glaucoma surgery over a 20-year period (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) by a single surgeon. Main outcome measures were pre-and postoperative intraocular pressures (IOPs), corneal clarity, visual acuities (VAs), refractive errors, success rate, time of surgical failure, and complications. Results The series consisted of 38 primary combined trabeculotomy-trabeculectomy (CTT) and 6 primary trabeculectomy procedures (Schlemm's canal could not be identified in these eyes). There was a statistically significant reduction in IOP postoperatively (27.07 ± 4.88 vs 14.88 ± 3.62 mm Hg; Po0.0001) with a mean reduction of 45.14%. Success probability by Kaplan-Meier survival analysis was 93% till 5 years, and then 88. 1%, 82.3%, 70.5%, 56.4%, and 42.3% at year 6, 7, 8, 9, and 10, respectively. Preoperative corneal edema was present in 43/44 eyes (97.72%) and cleared in 42 eyes (97.67%). There was one case each with intraoperative hyphema and with shallow chamber postoperatively and both were successfully managed successfully. There was no incidence of endophthalmitis or any other sight-threatening complication. Data on VA were available in 34 eyes (77.3%). At final follow-up visit, 15 (44.1%) eyes had best corrected VA ⩾ 6/18. Conclusions Primary CTT is safe and effective for early-onset glaucoma associated with ARA. It leads to excellent IOP control and satisfactory visual outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early-onset glaucoma in Axenfeld–Rieger anomaly: long-term surgical results and visual outcome

Mandal

Pehere²

2016

Eye

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“…However, one eye developed seclusio pupillae and cataract postoperatively. Mandal and colleagues [12][13][14][15]18,30 have reported only minor postoperative complications in their previous studies. Al-Hazmi et al 16 have reported more complications including exudative retinal detachment.…”

Section: Eyementioning

confidence: 97%

“…7,8,12 Recent reports have found combined trabeculotomy-trabeculectomy (CTT) to yield superior results in comparison with conventional procedures. [9][10][11][12][13][14][15][16] In Ghana, majority of children with PCG present with severe disease and cloudy cornea. Conventional trabeculectomy has been the surgical method commonly used for PCG treatment, but anecdotal data show poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

Essuman

Braimah

Ndanu

et al. 2010

Eye

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“…114,115 Combined trabeculotomy-trabeculectomy is sustained to be more successful than either procedure performed alone and that is the primary procedure of choice. [116][117][118] Trabeculectomy can be performed as a primary surgical procedure with satisfactory success rates in cases of repeated failed angle surgery and in most secondary glaucomas. The application of mitomycin C (MMC) in refractory glaucomas can counteract the vigorous wound healing response in children, but the complications, especially those related to hypotony (shallow or flat AC, hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage) and to bleb formation (blebitis, endophthalmitis, chronic bleb leak) often appear to increase.…”

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confidence: 99%

Pediatric glaucoma: current perspectives

Marchini¹,

Toscani²,

Chemello³

2014

PHMT

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"Childhood glaucoma" is a heterogeneous group of severe pediatric conditions often associated with significant visual loss and characterized by elevated intraocular pressure (IOP) and optic-disk cupping. Successful IOP control is crucial but challenging and most often achieved surgically, with medical therapy playing a supportive role. There are many classifications of childhood glaucoma, but they can simply be divided into primary, in which a developmental abnormality of the anterior chamber angle only exists, and secondary, in which aqueous outflow is reduced due to independent mechanisms that secondarily impair the function of the filtration angle. The worldwide prevalence of childhood blindness ranges from 0.03% in high-income countries to 0.12% in undeveloped countries. The majority of cases do not have an identified genetic mutation and, where the mutation is known, the genes often account for only a small proportion of cases. Several pathogenetic mechanisms are known to contribute to the development of childhood glaucoma. Whatever the cause, it results in a reduced aqueous outflow at the level of the trabecular meshwork. Age of onset and magnitude of the elevated IOP largely determine the clinical manifestation the high variability of clinical manifestations. Glaucoma from any cause in a neonate and infant is characterized by the classic triad of epiphora, photophobia, and blepharospasm, and could be associated with eye enlargement (buphthalmos) and Haab striae. The eye examination, usually performed under general anesthesia, includes: tonometry, anterior-segment examination, gonioscopy, corneal diameter and axial length measurement, dilated fundoscopy with optic-nerve-head evaluation. Medical therapy, considering the high frequency of side effects, is generally used as temporizing IOP-lowering treatment before surgery or as adjuvant treatment postoperatively in case of partially successful procedures for refractory glaucomas. Surgery is the nodal point of the management of refractory childhood glaucoma, so it is crucial to opt for a forward-looking strategy to reach the target IOP and minimize the visual loss.

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Primary Combined Trabeculotomy-Trabeculectomy for Developmental Glaucomas

Cited by 16 publications

References 9 publications

Early-onset glaucoma in Axenfeld–Rieger anomaly: long-term surgical results and visual outcome

Early-onset glaucoma in Axenfeld–Rieger anomaly: long-term surgical results and visual outcome

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

Pediatric glaucoma: current perspectives

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