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Shagun Bhatia, Jennifer Galvin, Ji Liu; Surgical Outcomes for a Population of Patients with Primary Congenital Glaucoma at Yale Eye Center. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6510. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Primary congenital glaucoma (PCG) in infancy results in visual morbidity in up to 50% of cases. Surgical management of PCG is challenging and prognosis is guarded. We examined the relationship between clinical manifestations and surgical intervention over a 2-year period.
IRB was completed and electronic chart review was conducted to include patients diagnosed with PCG evaluated at Yale Eye Center. Patients with secondary glaucoma, juvenile primary open angle glaucoma, and those with incomplete medical records were excluded. Visual acuity, intraocular pressure (IOP), corneal appearance and horizontal diameter, axial length, and cup-to-disc (C:D) ratio were recorded.
Ten patients (20 eyes) were examined at Yale Eye Center from 2013-2015: 70% were male, 30% were Hispanic, mean age at presentation was 16 months, and all had bilateral disease. Mean follow up was 15.1 months (range 3-29 months). At presentation, average IOP was 32.9mmHg, average corneal horizontal diameter was 12.5 mm and average vertical C:D ratio was 0.64. All 20 eyes with PCG had surgical intervention. Initial surgery included trabeculectomy (1 eye, 5%), goniotomy (2 eyes, 10%), glaucoma drainage device (GDD)(4 eyes, 20%) and trabeculotomy ab externo (13 eyes, 65%). Second surgeries included repeat goniotomy (1 eye, 7%), GDD revision (1 eye, 7%), GDD (5 eyes, 33%), and repeat trabeculotomy ab externo (8 eyes, 53%). The average number of surgeries per patient was 4.3 (range 1-6). Sixteen of 20 eyes had more than one surgery (80%). Sixty percent of the patients had lower IOP after surgery, with average post-op IOP of 22.8mmHg. There was no difference in the degree of IOP lowering effects between types of initial surgery (p>0.05). There was no correlation between average IOP, corneal diameter, C:D ratio, or axial length at presentation and total number of surgeries performed (r2<0.8 for all associations).
IIn our PCG patients, the association between initial clinical manifestations of disease and surgical intervention was not related to disease severity. The majority of our patients needed more than one surgery. At 2 years of follow-up, IOP was lowered on average by 10.6 mmHg, but degree of IOP lowering was independent of the initial surgery performed. Although our patient cohort is small, this is of clinical value when making treatment decisions for patients with PCG.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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