Long term outcomes of angle, filtering, and combined angle and filtering surgery for primary congenital glaucoma

Abstract

Purpose: To report on long term follow-up of surgical results in primary congenital glaucoma (PCG). Study design: Retrospective chart review. Methods: The charts of all children presenting with and operated on for PCG in Alexandria Main University Hospital between 2005 and 2013 and completing at least 8 years of follow-up were reviewed. Data extracted included demographic characteristics, prenatal history, glaucoma diagnosis, preoperative, intraoperative and postoperative data. Success was defined as an IOP ≤ 16 mmHg with no vision-threatening complications and no signs of progression (progressive increase in corneal diameter, axial length (AL), or cup/disc (C/D) ratio). Results: The records of 65 eyes of 41 children were reviewed. The mean ± standard deviation of the age at presentation was 5.9 ± 4.1 months and of follow-up was 128.3 ± 18.4 months. The most common presentation was cloudy cornea (53.7%). The total glaucoma surgical procedures were 96 (1.5 ± 0.8 procedures per eye, with 71% undergoing only 1 procedure). The most common initial glaucoma surgery was combined angle and filtering surgery with antimetabolite (56, 86.2%). At the final follow-up, IOP, AL and C/D ratio (12.4 ± 6.1 mmHg, 26.49 ± 3.5 mm and 0.3 ± 0.3) were statistically significantly different from preoperative values (19.0 ± 5.9 mmHg, 22.69 ± 1.86 mm and 0.5 ± 0.3) (p 0.2 in 56.25%. The mean ± standard deviation of the Mean Deviation (MD) and Pattern Standard Deviation (PSD) were -5.88 ± 2.9 and 3.22 ± 1.74 dB respectively. At the last follow-up, the success rate was 80%. Conclusions: Combined angle and filtering surgery with antimetabolite was successful for long term control of PCG. Refractive errors and amblyopia occur in over half of the operated eyes.

Keywords

• Primary congenital glaucoma
• Combined angle-filtering surgery
• Long-term
• Follow-up
• Visual acuity