Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14 mm or more.
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.
Mandal
A K
AK
Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India. mandal@lvpei.org
Matalia
J H
JH
Nutheti
R
R
Krishnaiah
S
S
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