Long-term results of combined viscotrabeculotomy-trabeculectomy in refractory developmental glaucoma.
BACKGROUND
To evaluate the outcomes of combined viscotrabeculotomy-trabeculectomy in patients with refractory developmental glaucoma and to compare the success and complication rates with classical trabeculotomy-trabeculectomy procedure.


METHODS
Patients who were selected for this study had cloudy corneas with a diameter of 13 mm or greater and with an initial intraocular pressure (IOP) of 27 mmHg or more, and they were divided into two groups. Group 1 consisted of 40 eyes of 24 patients who had undergone combined viscotrabeculotomy-trabeculectomy with a mean follow-up time of 55.6+/-18.4 months, and group 2 consisted of 35 eyes of 20 patients who had undergone classical trabeculotomy-trabeculectomy with a mean follow-up time of 57.2+/-19.0 months. Pre- and postoperative IOPs, mean antiglaucoma medication, mean corneal diameter, success rates, intra- and postoperative complications were compared between two groups.


RESULTS
Mean IOP reduced from a preoperative level of 33.2+/-5.3 and 32.8 mmHg to 14.2+/-3.1 and 15.3+/-3.3 in group 1 and group 2, respectively (P<0.001). The mean number of antiglaucoma medications used after surgery was significantly lower in group 1 (P<0.05). Kaplan-Meier survival analysis showed that the success probability at the last visits was 90 and 71.4% in group 1 and group 2, respectively, and the difference was statistically significant (P=0.01). The most common early postoperative complication was transient IOP elevation in group 1 and hyphema in group 2 (for each, P<0.001).


CONCLUSIONS
Use of viscoelastic materials during trabeculotomy-trabeculectomy may increase the success rate of the procedure by prevention of postoperative hemorrhage, anterior chamber shallowing, adhesion of the incision lips or fibroblastic proliferation.
Tamcelik
N
N
Department of Ophthalmology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
Ozkiris
A
A
Sarici
A M
AM
D000959:Antihypertensive Agents / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D011183:Postoperative Complications; D014130:Trabeculectomy / Q000379:methods*
D000959:Antihypertensive Agents