Clinical Study
Eye (2007) 21, 764–774; doi:10.1038/sj.eye.6702324; published online 31 March 2006
Surgical outcome of primary developmental glaucoma: a single surgeon's long-term experience from a tertiary eye care centre in India
Presented as a poster at the Association for Research in Vision and Ophthalmology meeting Fort Lauderdale, Florida, May 1–5, 2005
A K Mandal1, V K Gothwal2 and R Nutheti3
- 1Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, India
- 2Meera and LB Deshpande Centre for Sight Enhancement, Vision Rehabilitation Centres, LV Prasad Eye Institute, Hyderabad, India
- 3International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India
Correspondence: AK Mandal, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, LV Prasad Marg, Banjara Hills, Hyderabad 500 034, India Tel: +91 40 306 12345; Fax: +91 40 235 48271; E-mail: mandal@lvpei.org
Received 5 July 2005; Accepted 29 January 2006; Published online 31 March 2006.
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 14.95.9 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 20.325.6 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.
Keywords:
developmental glaucoma; surgical outcome, trabeculotomy, trabeculectomy, combined trabeculotomy and trabeculectomy, megalocornea
