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R. M. Saltzmann, S. R. Reinecke, J. T. Whitson; Long-Term Outcomes of Primary Trabeculotomy for Congenital Glaucoma at Children's Medical Center. Invest. Ophthalmol. Vis. Sci. 2010;51(13):605.
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To quantify the long-term outcomes of congenital glaucoma and surgical success rates following trabeculotomy surgery at our institution, Children's Medical Center (CMC) of Dallas.Patients and
An ICD-9 database was utilized to conduct a retrospective chart review. A minimum of 12 months follow-up was required for inclusion. 38 eyes of 24 patients who underwent primary pseudo-360 degree (i.e. two-site 180-degree Harms probe) trabeculotomy between 6/1/1992 and 12/31/2005 were studied, including 27 with primary congenital glaucoma, 1 with Rieger's anomaly, 6 with Sturge Weber syndrome, and 4 with aphakic glaucoma.
Mean age at the time of trabeculotomy was 11.1±3.0 months (range 0.3 - 102.5 months), with 7 eyes operated on after 1 year of age. Mean follow-up was 85.1 ± 9.0 months (range 16.6 - 199.4 months). Mean IOP at glaucoma diagnosis was 32.7±1.1 mmHg, and final IOP (after trabeculotomy and any additional surgical intervention) averaged 17.9±0.8 mmHg at most recent follow-up. With trabeculotomy and medication alone, mean post-operative IOP was 19.9±1.1 mmHg, with a mean drop in IOP of 12.5±1.4 mmHg. Surgical success was achieved in 30 eyes (78.96%) at most recent follow-up, meaning that primary trabeculotomy and medication provided sufficient IOP control without the need for additional intervention. Kaplan-Meier analysis demonstrated 5- and 10-year survival probabilities of 93.1% and 66.8%, respectively. 17 eyes (44.7% of all eyes, 56.7% of successful eyes) achieved complete success, meaning consistent IOP control < 21 mmHg without any additional medical treatment required. All 17 had primary congenital glaucoma; no eyes with aphakic glaucoma or Sturge-Weber syndrome achieved complete success. 7 eyes (18.4%) in 5 patients failed primary trabeculotomy, 6 of which were based upon a postoperative intraocular pressure (IOP) of >30 mmHg on 2 or more medications. Mean time to failure was 46.9±8.6 (range 11.7-66.9) months post-operative. The subgroup of eyes with Sturge-Weber syndrome fared significantly worse than those with primary congenital glaucoma, exhibiting an increased overall rate of failure (p = 0.009) and a 5.81 times relative risk of failure (p=0.026).
Trabeculotomy continues to have an excellent track record at CMC, with long-term surgical success rates that compare favorably with existing reports. Eyes with Sturge-Weber syndrome may warrant consideration of primary combined trabeculotomy/trabeculectomy or, at a minimum, closer post-operative surveillance after primary trabeculotomy.
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