title: Combined trabeculotomy-trabeculectomy with antimetabolite and releasable suture: outcome with primary congenital glaucoma in a north Indian population.
abstract: OBJECTIVE
  To determine the surgical outcomes of combined trabeculotomy- trabeculectomy with mitomycin-C and releasable suture in children with primary congenital glaucoma (PCG) in a North Indian population.
  
  
  METHODS
  Retrospective, interventional, consecutive, non-comparative case series.
  
  
  METHODS
  The medical records of 137 eyes of 77 patients who underwent combined trabeculotomy- trabeculectomy with 0.2 mg/ml mitomycin C (MMC) either bilaterally (49 patients) or unilaterally (28 patients) between January 2004 and March 2012 were reviewed retrospectively. The main outcome measures were postoperative intraocular pressures, corneal clarity and diameter, duration of follow-up, success rate and complications.
  
  
  RESULTS
  The mean preoperative intraocular pressure reduced from 34 ± 7 mm Hg (range 15- 54 mm Hg) to 17 ± 7 mm Hg (range 5 - 32 mm Hg) with a mean reduction of 44 % (P less than 0.001). The mean follow-up period was 24.4 ± 10.3 months (range 6 - 48 months). Complete success defined as intraocular pressure less than 21 mm Hg without any medication and clinically stable glaucoma at last follow-up was achieved in 113 eyes (83 %) while a 'qualified success' of intraocular pressure less than 21 mm Hg with one medication was achieved in ten eyes (7 %). The Kaplan-Meier survival analysis revealed success rates (at 'n' months) of 90 % (6), 85 % (12), 82 % (24), 80 % (36) and 77 % (48). There were no significant intraoperative or postoperative complications.
  
  
  CONCLUSIONS
  Primary combined trabeculotomy-trabeculectomy with mitomycin-C and releasable suture offers a viable surgical option in Northern Indian infants with primary congenital glaucoma. The use of 0.2 mg/ml mitomycin C for 2 minutes improves the overall success while the releasable suture decreases the risk of postoperative complications especially associated with the use of antimetabolites.
authors.affiliation: Dr Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj New Delhi 110002, India.
authors.forename: S
authors.initials: S
authors.lastname: Dubey
authors.forename: A
authors.initials: A
authors.lastname: Agrawal
authors.forename: L
authors.initials: L
authors.lastname: Chauhan
authors.forename: S
authors.initials: S
authors.lastname: Mukherjee
authors.forename: G
authors.initials: G
authors.lastname: Douglas
mesh_terms: D000293:Adolescent; D000477:Alkylating Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006068:Gonioscopy; D006801:Humans; D006871:Hydrophthalmos / Q000503:physiopathology / Q000601:surgery*; D007194:India; D007223:Infant; D007231:Infant, Newborn; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage*; D042262:Retinoscopy; D012189:Retrospective Studies; D013536:Suture Techniques; D014130:Trabeculectomy / Q000379:methods*
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin