Surgical outcome of primary developmental glaucoma: a single surgeon's long-term experience from a tertiary eye care centre in India.
OBJECTIVE
To determine the surgical outcome after initial surgery in children with primary developmental glaucoma (PDG).


METHODS
Six hundred and twenty-four eyes of 360 consecutive patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) for PDG from January 1990 to June 2004 were studied. The main outcome measures were pre- and postoperative intraocular pressures (IOPs), corneal clarity, visual acuities, refractive errors, success rate, time of surgical failure, complications, and factors associated with poor outcome.


RESULTS
IOP reduced from 28.1+/-7.5 to 14.9+/-5.9 mmHg (P<0.0001). Probability of success (IOP<21 mmHg) was 85.2, 80.4, 77.2, 72.6, 66.2, and 57.5% at first, second, third, fourth, fifth, and sixth years, respectively (Kaplan-Meier analysis). The mean follow-up period was 20.3+/-25.6 months (median, 6 months). Preoperatively, 243 eyes (67.5%) had significant corneal oedema. Postoperatively, normal corneal transparency was achieved in 162 eyes (46.0%). Data on Snellen visual acuity were available in 100 patients (27.8%). At the final follow-up visit, 42 patients (42.0%) had normal visual acuity (>or=20/60). Myopia (mean spherical equivalent, 6.1 D) was the most common (75.0%) refractive error. In multivariate analyses, failure increased by three-fold in the presence of preoperative IOP>35 mmHg (hazards ratio (HR)=3.12; 95% confidence interval (CI), 1.4-6.7) and two-fold in cases with a history of prior glaucoma surgery (HR=2.57; 95% CI, 1.1-6.0). There were no major intraoperative complications, bleb-related infection, or endophthalmitis.


CONCLUSIONS
This series shows that prolonged IOP control can be achieved in patients with PDG and 42% of the patients gained normal visual acuity.
Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, India. mandal@lvpei.org
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Mandal
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Gothwal
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Nutheti
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000758:Anesthesia / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000473:pathology; D004812:Epidemiologic Methods; D005901:Glaucoma / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D007429:Intraocular Pressure; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D012030:Refractive Errors / Q000209:etiology; D014130:Trabeculectomy / Q000009:adverse effects; D016896:Treatment Outcome; D014792:Visual Acuity