Abstract
Purpose
Assess long-term outcome of combined trabeculotomy–trabeculectomy (CTT) in primary congenital glaucoma (PCG).
Methods
Data of PCG patients treated with CTT by a single surgeon between 1976 and 1993 were reviewed for reduction in intraocular pressure (IOP), visual acuities, surgical success rates, and need for repeat surgeries at last follow-up (FU). At the last FU, IOP<21 mm Hg without any topical antiglaucoma medication (TAM) was complete success and with 1-2 TAMs was qualified success. IOP reduction ≥30% without any TAM was modified complete success and with 1–2 TAMs was modified qualified success. IOP>21 mm Hg, IOP reduction <30%, or use of >2 TAM at last FU, or need for additional surgery was considered as failure.
Results
Two hundred thirty eyes of 121 patients had been followed up for 21.5–38 years (mean 28.87±2.77 years). Eyes that were pthisical (3), had immeasurable IOP (2), or IOP<6 mm Hg (3) were excluded from the success analysis. At last FU, mean IOP reduction was 22.71±11.28 mm Hg and TAM score was 1.71 (0–4). Complete success was achieved in 14 (6.3%), modified complete success in 14 (6.3%), qualified success in 148 (66.7%), and modified qualified success in 140 (63.1%). Success probability was 95% till 25 years and 92, 90, 85, 79 and 68% at 26, 27, 28, 29, and 30 years, respectively. Severe visual impairment or functional blindness was found in only 13 (10.7%) patients.
Conclusion
CTT shows long-term success in PCG patients. All patients must be monitored for IOP control to avoid need for repeat surgeries.
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Acknowledgements
All combined trabeculotomy–trabeculectomies were done by Prof Narender Nath Sood while at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi from where he retired in 1993. This study was funded by SK Glaucoma Care Foundation, New Delhi and PFC Pharma Focus India Pvt Ltd helped with the data analysis and preparation of the first draft of the manuscript.
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Sood, D., Rathore, A., Sood, I. et al. Long-term outcome of combined trabeculotomy–trabeculectomy by a single surgeon in patients with primary congenital glaucoma. Eye 32, 426–432 (2018). https://doi.org/10.1038/eye.2017.207
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DOI: https://doi.org/10.1038/eye.2017.207
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