Primary congenital glaucoma presenting within the first three months of life in a Bedouin population: prognostic factors.
OBJECTIVE
To analyze the final outcome of surgery in Arab-Bedouin children with primary congenital glaucoma (PCG) presenting within the first three months of life, and to search for prognostic factors for success.


METHODS
Retrospective study of all cases with follow-up of at least 24 months.


METHODS
Twenty-five Arab-Bedouin children (45 eyes) with PCG presenting within the first three months of life who underwent surgical procedures at the Soroka University Medical Center from January 1988 to December 1998.


METHODS
Patient's age, family history, main presenting features, data from examinations under anesthesia, including intraocular pressure (IOP), horizontal corneal diameter, and cup/disc (c/d) ratio, and the type of surgery performed were reviewed.


METHODS
Success of the first operation, defined as final IOP < 21 mm Hg achieved after only one surgical procedure without anti-glaucoma medication, and final outcome, defined as good when IOP was < 21 mm Hg and > 5 mm Hg at the end of a 24-month follow-up period without anti-glaucoma medication, irrespective of the number of procedures performed.


RESULTS
At presentation mean IOP was 36.2 +/- 8.0 mm Hg, corneal diameter was 12.62 +/- 0.98 mm, and c/d ratio was 0.41 +/- 0.16. The mean age at first operation was 17 +/- 20 days, and median of 5 days. The mean follow-up period was 37.4 +/- 25.4 months. The success of the first operation performed was not related to the type of operation (P = 0.22), gender (P = 0.47), consanguinity (P = 1.0), family history (P = 0.12), clinical presentation (P = 0.81), or age at first operation (P = 0.38). Eyes with high initial IOP and greater c/d ratio were at a significantly higher risk for failure (P = 0.05, P = 0.04, respectively). A final outcome of IOP under 21 mm Hg and above 5 mm Hg was achieved in 39 eyes (86.5%). There was no statistical association between final outcome and the type of first surgical procedure performed, gender, consanguinity, clinical presentation, and age at first operation. Cases with no family history had a significantly better final outcome (P = 0.05). In multivariate analysis only initial IOP showed borderline significance as an independent risk factor for final outcome (P = 0.06).


CONCLUSIONS
Initial high IOP and higher c/d ratio were found to be predictive factors for failure of the first procedure. Final outcome was significantly better in cases with no family history, yet initial IOP was the only independent predictive factor for failure at the final outcome in a multivariate model. Findings of this type have not been previously reported, and they may constitute an important tool in predicting the treatment outcome of very young children with PCG.
Levy
Jaime
J
Department of Ophthalmology, Soroka University Medical Center, Beer-Sheva 84101, Israel. ljaime@bgumail.bgu.ac.il
Carmi
Rivka
R
Rosen
Shirley
S
Lifshitz
Tova
T
D018912:Arabs / Q000208:ethnology*; D005260:Female; D005901:Glaucoma / Q000151:congenital* / Q000175:diagnosis / Q000208:ethnology* / Q000601:surgery; D020327:Glaucoma Drainage Implants; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007429:Intraocular Pressure; D007557:Israel / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000379:methods