Rengappa Ramkrishanan1, Arijit Mitra, Mohideen Abdul Kader. 1. From the Aravind-Ziess Centre for Excellence in Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, South India.
Abstract
PURPOSE: This study aimed to categorize patients with childhood glaucoma into groups, study the clinical characteristics of the eyes affected, and determine the outcomes after surgery. DESIGN: This was a retrospective, consecutive, nonrandomized study. METHODS: Patients with childhood glaucoma who underwent planned primary trabeculectomy or combined trabeculotomy-trabeculectomy (CTT) between January 2003 and December 2008 were enrolled. Main outcome measures were intraocular pressure (IOP), visual acuity, corneal clarity, and any surgical and anesthetic complications. RESULTS: One hundred thirty-one eyes of 81 patients were included. They were 61.7% male. Mean patient age was 6.1 ± 4.1 years, and the mean age at surgery was 35.8 ± 40.9 months. Postoperatively, the improvement in visual acuity was highly statistically significant at all follow-ups (P < 0.001). The IOP values showed a significant reduction from 29.2 ± 9.7 mm Hg preoperatively to 13.7 ± 5.3 mm Hg (P < 0.001) at 6-month follow-up and 12.1 ± 2.2 mm Hg at last follow-up. Cumulative corneal clarity improved significantly postoperatively (P < 0.001). A comparison of trabeculectomy alone and CTT showed that both procedures were quite effective. At 1 year, overall complete success was seen in 73.3%, qualified success in 16.8%, and failure in 10.7%. CONCLUSIONS: This study suggests that CTT is safe and effective in both primary and secondary childhood glaucomas. Trabeculectomy alone is also highly effective in certain cases, and proper case selection is essential to attain optimum results. Surgical intervention leads to improvement in vision and corneal clarity and also achieves long-term IOP control.
PURPOSE: This study aimed to categorize patients with childhood glaucoma into groups, study the clinical characteristics of the eyes affected, and determine the outcomes after surgery. DESIGN: This was a retrospective, consecutive, nonrandomized study. METHODS:Patients with childhood glaucoma who underwent planned primary trabeculectomy or combined trabeculotomy-trabeculectomy (CTT) between January 2003 and December 2008 were enrolled. Main outcome measures were intraocular pressure (IOP), visual acuity, corneal clarity, and any surgical and anesthetic complications. RESULTS: One hundred thirty-one eyes of 81 patients were included. They were 61.7% male. Mean patient age was 6.1 ± 4.1 years, and the mean age at surgery was 35.8 ± 40.9 months. Postoperatively, the improvement in visual acuity was highly statistically significant at all follow-ups (P < 0.001). The IOP values showed a significant reduction from 29.2 ± 9.7 mm Hg preoperatively to 13.7 ± 5.3 mm Hg (P < 0.001) at 6-month follow-up and 12.1 ± 2.2 mm Hg at last follow-up. Cumulative corneal clarity improved significantly postoperatively (P < 0.001). A comparison of trabeculectomy alone and CTT showed that both procedures were quite effective. At 1 year, overall complete success was seen in 73.3%, qualified success in 16.8%, and failure in 10.7%. CONCLUSIONS: This study suggests that CTT is safe and effective in both primary and secondary childhood glaucomas. Trabeculectomy alone is also highly effective in certain cases, and proper case selection is essential to attain optimum results. Surgical intervention leads to improvement in vision and corneal clarity and also achieves long-term IOP control.