Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14 mm or more

Abstract

Purpose To report the safety and efficacy of combined trabeculotomy and trabeculectomy (CTT) in advanced primary developmental glaucoma with corneal diameter 14 mm or more. Patients and Methods A total of 74 (121 eyes) consecutive patients aged 3 days-100 months (median, 10 months) with advanced developmental glaucoma were included. Primary CTT was performed by a single surgeon at a tertiary eye care centre in India over a 13-year period. The main outcome measures were changes in and final levels of intraocular pressure (IOP), corneal clarity, visual acuity, and refractive status. Results Mean preoperative IOP was 29.477.6 mmHg (range, 10-56 mmHg) and mean postoperative IOP was 15.576.6 mmHg (range, 6-38 mmHg) (Po0.0001) with percentage reduction of 44.5727.1. KaplanMeier survival analysis revealed 3-, 6-, 9-, 12-, 24-, 48-, and 72-month success rates of 86.5, 80.5, 78.1, 75.5, 71.1, and 60.5%, respectively. Majority (80.5%) of the patients were myopes with mean spherical equivalent of 5.874.5D (range, 0.75-22.0D). Using various ageappropriate testing procedures, at the final follow-up visit, 14 patients (41.2%) had age-appropriate normal visual acuity and 20 patients (58.8%) had subnormal visual acuity. Best-spectacle-corrected visual acuity of X20/60 was achieved in seven patients (26.9%). There were no sightthreatening intraoperative and postoperative complications.Conclusion CTT is safe and effective in patients with advanced primary developmental glaucoma. It offers good IOP control with a low complication rate, with about one-third of patients achieving a visual acuity of 20/60 or better.

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

“…11,13 Studies from India and the Middle East corroborate the fact that CTT is superior to trabeculectomy in the treatment of PCG. 11,13,16,30 There was significant reduction of IOP from mean preoperative level of 30.3-18.1 mm Hg postoperatively. This is hoped to influence outcome as elevated IOP resulting from maldevelopment of angle structures is considered a significant factor in the pathogenesis of optic nerve and other ocular damage in PCG.…”

“…Other studies by Mandal and colleagues, and others from the Middle East have also noted that majority of patients with PCG had significant corneal oedema at presentation. 9,12,30 Of 15, 4 (27%) eyes that achieved surgical success had flat and scarred blebs. This success probably may be due to the dual outflow pathway provided by CTT as emphasized by Elder, 11 and Mandal et al 13 Most of the complications encountered in our patients were minor.…”

Early-onset glaucoma in Axenfeld–Rieger anomaly: long-term surgical results and visual outcome

“…20,21 The most compelling argument favoring primary CTT in early-onset glaucoma in ARA was the higher incidence of successful IOP control with a single operative procedure as has been already reported by us. [12][13][14][15][16][17][18] The aim of the present study as to evaluate the surgical outcome of infants with secondary glaucoma associated with ARA. Kaplan-Meier survival analysis demonstrated the probability of complete success of 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.…”

“…This technique has been previously described by us. [16][17][18][19] In brief, the Schlemm's canal was dissected under a partial thickness limbal-based triangular scleral flap and trabeculotomy ab externo was performed on both sides of the radial incision. Trabeculectomy was then performed in the usual manner.…”

“…He advocated trabeculectomy possibly with antimetabolites in this situation. 1 Mandal et al [10][11][12][13][14][15][16][17][18] reported combined trabeculotomy-trabeculectomy (CTT) as a successful surgical procedure in primary developmental glaucoma as well as early-onset glaucoma in Sturge-Weber syndrome. The aim of the present study was to evaluate our surgical results in early-onset glaucoma in ARA.…”