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A.K. Mandal, R. Nutheti; Surgical Outcome of Primary Developmental Glaucoma: A Single Surgeon’s Long–term Experience From a Tertiary Eye Care Centre in India . Invest. Ophthalmol. Vis. Sci. 2005;46(13):132.
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Purpose: To determine the surgical outcome after initial surgery in children with primary developmental glaucoma (PDG).Methods: 624 eyes of 360 consecutive patients who underwent primary combined trabeculotomy–trabeculectomy (CTT) for PDG from January 1990 through June 2004 were studied. Patient–based risk of failure was evaluated using Cox proportional hazard regression models and was expressed as hazards ratio (HR) with 95% confidence intervals (95%CI). The main outcome measures were pre and postoperative IOPs, corneal clarity, visual acuities, refractive errors, success rate, time of surgical failure, complications and factors associated with a poor outcome. Results: The IOP reduced from 28.1 ± 7.5 mmHg to 14.9 ± 5.9 mmHg (P < 0.0001). The probability of success (IOP 20/60). Myopia (mean SE, 6.1D) was the most common (75.0%) refractive error. In multivariate analyses, failure increased by three–fold in the presence of preoperative IOP > 35mmHg (HR = 3.12; 95% 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). No other factors were identified. There were no major intraoperative complications. Postoperatively 1 eye (0.3%) developed choroidal detachment that was successfully managed conservatively. Four eyes (1.1%) required enucleation because of painful blind eye secondary to absolute glaucoma. Rhegmatogenous retinal detachment occurred in 8 (2.2%) eyes; 4 eyes underwent successful vitreo–retinal procedures and these eyes regained the baseline visual acuity. Four eyes were deemed inoperable due to total RD with proliferative vitreoretinopathy. There was no incidence of bleb–related infection or endophthalmitis.Conclusions: This series shows that prolonged IOP control can be achieved in patients with PDG and approximately one–third of the patients gained age–appropriate normal visual acuity. Barriers to good functional outcome included magnitude of IOP at presentation and history of prior failed glaucoma surgery.
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