title: Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14 mm or more.
abstract: OBJECTIVE
  To report the safety and efficacy of combined trabeculotomy and trabeculectomy (CTT) in advanced primary developmental glaucoma with corneal diameter 14 mm or more.
  
  
  METHODS
  A total of 74 (121 eyes) consecutive patients aged 3 days-100 months (median, 10 months) with advanced developmental glaucoma were included. Primary CTT was performed by a single surgeon at a tertiary eye care centre in India over a 13-year period. The main outcome measures were changes in and final levels of intraocular pressure (IOP), corneal clarity, visual acuity, and refractive status.
  
  
  RESULTS
  Mean preoperative IOP was 29.4+/-7.6 mmHg (range, 10-56 mmHg) and mean postoperative IOP was 15.5+/-6.6 mmHg (range, 6-38 mmHg) (P<0.0001) with percentage reduction of 44.5+/-27.1. Kaplan-Meier survival analysis revealed 3-, 6-, 9-, 12-, 24-, 48-, and 72-month success rates of 86.5, 80.5, 78.1, 75.5, 71.1, and 60.5%, respectively. Majority (80.5%) of the patients were myopes with mean spherical equivalent of 5.8+/-4.5D (range, 0.75-22.0D). Using various age-appropriate testing procedures, at the final follow-up visit, 14 patients (41.2%) had age-appropriate normal visual acuity and 20 patients (58.8%) had subnormal visual acuity. Best-spectacle-corrected visual acuity of > or =20/60 was achieved in seven patients (26.9%). There were no sight-threatening intraoperative and postoperative complications.
  
  
  CONCLUSIONS
  CTT is safe and effective in patients with advanced primary developmental glaucoma. It offers good IOP control with a low complication rate, with about one-third of patients achieving a visual acuity of 20/60 or better.
authors.affiliation: Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India. mandal@lvpei.org
authors.forename: A K
authors.initials: AK
authors.lastname: Mandal
authors.forename: J H
authors.initials: JH
authors.lastname: Matalia
authors.forename: R
authors.initials: R
authors.lastname: Nutheti
authors.forename: S
authors.initials: S
authors.lastname: Krishnaiah
mesh_terms: D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005901:Glaucoma / Q000151:congenital* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007429:Intraocular Pressure; D008297:Male; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000150:complications; D012189:Retrospective Studies; D016019:Survival Analysis; D014130:Trabeculectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity