title: Early-onset glaucoma in Axenfeld-Rieger anomaly: long-term surgical results and visual outcome.
abstract: PurposeTo determine the long-term surgical and visual outcomes in Indian children with early-onset glaucoma associated with Axenfeld-Rieger anomaly (ARA).MethodsThis is a retrospective analysis of 44 eyes of 24 consecutive children with early-onset glaucoma (within 3 years of age) and ARA who underwent glaucoma surgery over a 20-year period (1991-2010) by a single surgeon. Main outcome measures were pre- and postoperative intraocular pressures (IOPs), corneal clarity, visual acuities (VAs), refractive errors, success rate, time of surgical failure, and complications.ResultsThe series consisted of 38 primary combined trabeculotomy-trabeculectomy (CTT) and 6 primary trabeculectomy procedures (Schlemm's canal could not be identified in these eyes). There was a statistically significant reduction in IOP postoperatively (27.07±4.88 vs 14.88±3.62 mm Hg; P<0.0001) with a mean reduction of 45.14%. Success probability by Kaplan-Meier survival analysis was 93% till 5 years, and then 88.1%, 82.3%, 70.5%, 56.4%, and 42.3% at year 6, 7, 8, 9, and 10, respectively. Preoperative corneal edema was present in 43/44 eyes (97.72%) and cleared in 42 eyes (97.67%). There was one case each with intraoperative hyphema and with shallow chamber postoperatively and both were successfully managed successfully. There was no incidence of endophthalmitis or any other sight-threatening complication. Data on VA were available in 34 eyes (77.3%). At final follow-up visit, 15 (44.1%) eyes had best corrected VA ⩾6/18.ConclusionsPrimary CTT is safe and effective for early-onset glaucoma associated with ARA. It leads to excellent IOP control and satisfactory visual outcome.
authors.affiliation: Jasti V Ramanamma Children's Eye Care Centre, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
authors.forename: A K
authors.initials: AK
authors.lastname: Mandal
authors.affiliation: The David Brown Children's Eye Care Centre, Kode Venkatadri Chowdary Campus, Vijayawada, India.
authors.forename: N
authors.initials: N
authors.lastname: Pehere
mesh_terms: D000869:Anterior Eye Segment / Q000002:abnormalities* / Q000503:physiopathology; D002675:Child, Preschool; D015715:Corneal Edema / Q000503:physiopathology; D005124:Eye Abnormalities / Q000150:complications* / Q000503:physiopathology; D015785:Eye Diseases, Hereditary; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D012030:Refractive Errors / Q000503:physiopathology; D012189:Retrospective Studies; D014130:Trabeculectomy; D014792:Visual Acuity / Q000502:physiology*