Abstract
Purpose
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 (≥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.
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References
deLuise VP, Anderson DR . Primary infantile glaucoma.(Congenital glaucoma). Surv Ophthalmol 1983; 28: 1–19.
Shaffer RN . Prognosis of goniotomy in primary infantile glaucoma (trabeculodysgenesis). Trans Am Ophthalmol Soc 1982; 80: 321–325.
Haas J . Principles and problems of therapy in congenital glaucoma. Invest Ophthalmol 1968; 7: 140–146.
Shaffer RN, Hoskins HD . Montgomery lecture. Goniotomy in the treatment of isolated trabeculodysgenesis (primary congenital [infantile] developmental glaucoma). Trans Ophthalmol Soc UK 1983; 103: 581–585.
Stamper RL, Lieberman MF, Drake MV (eds). Becker–Shaffer's Diagnosis and Therapy of the Glaucomas. 7th edn. CV Mosby Co.: St Louis, 1999, pp 386, 668.
Barkan O . Technique of goniotomy. Arch Ophthalmol 1938; 19: 217–223.
Barkan O . Operation for congenital glaucoma. Am J Ophthalmol 1942; 25: 552–568.
Broughton WL, Parks MM . An analysis of treatment of congenital glaucoma by goniotomy. Am J Ophthalmol 1981; 91: 566–572.
Hoskins Jr HD, Shaffer RN, Hetherington J . Goniotomy vs trabeculotomy. J Pediatr Ophthalmol Strabismus 1984; 21: 153–158.
Anderson DR . Trabeculotomy compared to goniotomy for glaucoma in children. Ophthalmology 1983; 90: 805–806.
Khaw PT . What is the best primary surgical treatment for the infantile glaucomas? [editorial). Br J Ophthalmol 1996; 80: 495–496.
Luntz MH . The advantages of trabeculotomy over goniotomy. J Pediatr Ophthalmol Strabismus 1984; 21: 150–153.
McPherson Jr SD, Berry DP . Goniotomy vs external trabeculotomy for developmental glaucoma. Am J Ophthalmol 1983; 95: 427–431.
Panicker SG, Reddy ABM, Mandal AK, Ahmed N, Nagarajaram HA, Hasnain SE et al. Identification of novel mutations causing familial primary congenital glaucoma in Indian pedigrees. Invest Ophthalmol Vis Sci 2002; 43: 1358–1366.
Reddy ABM, Panicker SG, Mandal AK, Hasnain SE, Balasubramanian D . Identification of R368H as a predominant CYP1B1 allele causing primary congenital glaucoma in Indian patients. Invest Ophthalmol Vis Sci 2003; 44: 4200–4203.
Elder MJ, Cock RD . Childhood blindness in the West Bank and Gaza strip: prevalence, aetiology and hereditary factors. Eye 1993; 7: 580–583.
Jaffar MS . Care of the Infantile Glaucoma Patient. Ophthalmology Annual, Vol. 7. Raven Press: New York, 1988, pp 15–37.
Harms H, Danheim R . Trabeculotomy – results and problems. Adv Ophthalmol 1965; 22: 121–131.
Harms H, Danheim R . Epicritical consideration of 300 cases of trabeculotomy ‘ab externo’. Trans Ophthalmol Soc UK 1970; 89: 491–499.
McPherson Jr SD . Results of external trabeculotomy. Am J Ophthalmol 1973; 76: 18–20.
McPherson Jr SD, McFarland D . External trabeculotomy for developmental glaucoma. Ophthalmology 1980; 87: 302–305.
Quigley HA . Childhood glaucoma: results with trabeculotomy and study of reversible cupping. Ophthalmology 1982; 89: 219–226.
Akimoto M, Tanihara H, Negi A, Nagata M . Surgical results of trabeculotomy ab Externo for developmental glaucoma. Arch Ophthalmol 1994; 112: 1540–1544.
Richardson KT, Ferguson WJ, Shaffer RN . Long-term functional results in infantile glaucoma. Trans Am Acad Opthalmol Otolaryngol 1967; 71: 833–837.
Biglan AW, Hiles DA . The visual results following infantile glaucoma surgery. J Pediatr Ophthalmol Strabismus 1979; 16: 377–381.
Morgan KS, Black B, Ellis FD, Helveston EM . Treatment of congenital glaucoma. Am J Ophthalmol 1981; 92: 799–803.
Luntz MH . Congenital, infantile, and juvenile glaucoma. Ophthalmology 1979; 86: 793–802.
Elder MJ . Combined trabeculotomy–trabeculectomy compared with primary trabeculectomy for congenital glaucoma. Br J Ophthalmol 1994; 78: 745–748.
O’Connor G . Combined trabeculotomy–trabeculectomy for congenital glaucoma. Br J Ophthalmol 1994; 78: 735.
Al-Hazmi A, Zwaan J, Awad A, Al-Mesfer S, Mullaney PB, Wheeler DT et al. Effectiveness and complications of mitomycin-C use during pediatric glaucoma surgery. Ophthalmology 1998; 105: 1915–1920.
Mullaney PB, Selleck, Al-Award A, Al-Mesfer S, Zwaan J . Combined trabeculotomy and trabeculectomy as initial procedure in uncomplicated congenital glaucoma. Arch Ophthalmol 1999; 117: 457–460.
Mandal AK, Naduvilath TJ, Jayagandhan A . Surgical results of combined trabeculotomy–trabeculectomy for developmental glaucoma. Ophthalmology 1998; 105: 974–982.
Mandal AK . Primary combined trabeculotomy–trabeculectomy for early onset glaucoma in Sturge–Weber syndrome. Ophthalmology 1999; 106: 1621–1627.
Mandal AK, Bhatia PG, Gothwal VK, Reddy VM, Sriramulu P, Prasad MS et al. Safety and efficacy of simultaneous bilateral primary combined trabeculotomy–trabeculectomy for developmental glaucoma in India. Indian J Ophthalmol 2002; 50: 13–19.
Mandal AK, Gothwal V, Bagga H, Nutheti R, Mansoori T . Outcome of surgery on infants younger than 1 month with congenital glaucoma. Ophthalmology 2003; 110: 1909–1915.
Mandal AK, Bhatia PG, Bhaskar A, Nutheti R . Long-term surgical and visual outcomes in Indian children with developmental glaucoma operated on within 6 months of birth. Ophthalmology 2004; 111: 283–290.
Teller DY, McDonald MA, Preston K, Sebris SL, Dobson V . Assessment of visual acuity in infants and children: the acuity card procedure. Dev Med Child Neurol 1986; 28: 779–789.
Trueb L, Evans J, Hammel A, Bartholomew P, Dobson V . Assessing visual acuity of visually impaired children using the Teller Acuity Card procedure. Am Orthopt J 1992; 42: 149–154.
Mayer DL, Beiser AS, Warner AF, Pratt EM, Raye KN, Lang JM et al. Monocular acuity norms for the Teller Acuity Cards between ages one month and four years. Invest Ophthalmol Vis Sci 1995; 36: 671–685.
Hyvarinen L, Nasanen R, Laurinen P . New visual acuity test for preshool children. Acta Ophthalmol (Kbh) 1980; 58: 507–511.
Bailey IL, Lovie-Kitchin JE . New design principles for visual acuity letter charts. Am J Optom Physiol Opt 1976; 53 (11): 740–745.
Hatton DD . Model registry of early childhood visual impairment: first-year results. J Vis Imp Blindness 2001; 95 (7): 418–433.
Belkin M, Ticho U, Susal A, Levinson A . Ultrasonography in refraction of aphakic infants. Br J Ophthalmol 1973; 57: 845–848.
Gordon RA, Doniz BB . Refractive development of the human eye. Arch Ophthalmol 1985; 103: 785–789.
International Statistical Classification of Diseases and Related Health Problems (ICD). 10th revision. Vol. 1. WHO: Geneva, 1992, pp 456–457.
Mandal AK . Current concepts in the diagnosis and management of developmental glaucomas. Indian J Ophthalmol 1993; 41: 51–70.
Mandal AK . Microsurgical technique combines trabeculotomy and trabeculectomy to treat developmental glaucoma. Ocular Surg News Int Ed 1994; 5 (8): 38–43.
Newcombe RG, Duff GR . Eyes or patients? Traps for the unwary in the statistical analysis of ophthalmological studies. Br J Ophthalmol 1987; 71: 645–646.
Cox DR . Regression models and life-tables (with discussion). J R Stat Assoc 1972; 34: 187–220.
Russell-Eggitt I . In defence of goniotomy [letter]. Br J Ophthalmol 1995; 79: 709.
Burke JP, Bowell R . Primary trabeculectomy in congenital glaucoma. Br J Ophthalmol 1989; 73: 186–190.
Fulcher T, Chan J, Lanigan B, Bowell R, O’Keefe M . Long-term follow-up of primary trabeculectomy for primary infantile glaucoma. Br J Ophthalmol 1996; 80: 499–502.
Debnath SC, Teichmann KD, Salamah K . Trabeculectomy vs trabeculotomy in congenital glaucoma. Br J Ophthalmol 1989; 73: 608–611.
Rao KV, Sai CM, Babu BVN . Trabeculectomy in congenital glaucoma. Indian J Ophthalmol 1984; 32: 439–440.
Beck AD, Lynch MG . 360° trabeculotomy for primary congenital glaucoma. Arch Ophthalmol 1995; 113: 1200–1202.
Mendicino ME, Lynch MG, Drack A, Beck AD, Harbin T, Pollard Z et al. Long-term surgical and visual outcomes in primary congenital glaucoma: 360° trabeculotomy vs goniotomy. J AAPOS 2000; 4: 205–210.
Filous A, Brunova B . Results of the modified trabeculotomy in the treatment of primary congenital glaucoma. J AAPOS 2002; 6: 182–186.
Mandal AK, Walton DS, John T, Jayagandhan A . Mitomycin-C augmented trabeculectomy in refractory congenital glaucoma. Ophthalmology 1997; 104: 996–1001.
Mandal AK, Prasad K, Naduvilath TJ . Surgical results and complications of Mitomycin-C augmented trabeculectomy in refractory developmental glaucoma. Ophthalmic Surg Lasers 1999; 30: 473–480.
Biedner BZ, Rothkoff L . Combined trabeculotomy–trabeculectomy compared with primary trabeculotomy for congenital glaucoma. J Pediatr Ophthalmol Strabismus 1998; 35: 49–50.
Dietlein TS, Jacob PC, Krieglstein GK . Prognosis of primary ab externo surgery for primary congenital glaucoma. Br J Ophthalmol 1999; 83: 317–322.
Scheie Harold G . The management of infantile glaucoma. Arch Ophthalmol 1959; 62: 35–54.
Robin AL, Quigley HA, Pollack IP, Maumenee AE, Maumenee IH . An analysis of visual acuity, visual fields, and disc cupping in childhood glaucoma. Am J Ophthalmol 1979; 88: 847–858.
Litinsky SM, Shaffer RN, Hetherington J, Hoskins HD . Operative complications of goniotomy. Trans Am Ophthalmol Oto 1977; 83: 78–79.
Russell-Eggitt IM, Rice NS, Jay B, Wyse RK . Relapse following goniotomy for congenital glaucoma due to trabecular dysgenesis. Eye 1992; 6: 197–200.
Rice NSC . The surgical management of the congenital glaucomas. Aust J Ophthalmol 1977; 5: 174–179.
Acknowledgements
Supported in part by the Hyderabad Eye Research Foundation, LV Prasad Eye Institute, Hyderabad, India.
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Presented as a poster at the Association for Research in Vision and Ophthalmology meeting Fort Lauderdale, Florida, May 1–5, 2005
The authors have no proprietary interest in any of the materials or techniques used in this study.
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Mandal, A., Gothwal, V. & Nutheti, R. Surgical outcome of primary developmental glaucoma: a single surgeon's long-term experience from a tertiary eye care centre in India. Eye 21, 764–774 (2007). https://doi.org/10.1038/sj.eye.6702324
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DOI: https://doi.org/10.1038/sj.eye.6702324
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