June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
One-year Surgical Outcomes of Eyes with Primary Congenital Glaucoma Treated with Combined Trabeculotomy-Trabeculectomy Supplemented with Mitomycin C.
Author Affiliations & Notes
  • Andrea Tornero-Jimenez
    Research, Global Glaucoma Institute, Guadalajara, Jalisco, Mexico
    Instituto de Oftalmología y Ciencias Visuales, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Jose A Paczka
    Research, Global Glaucoma Institute, Guadalajara, Jalisco, Mexico
    Instituto de Oftalmología y Ciencias Visuales, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Montserrat Romo Sainz
    Research, Global Glaucoma Institute, Guadalajara, Jalisco, Mexico
  • Yesenia Yolanda Dorantes Diez
    Research Department, Centro de Diagnóstico y Control del Glaucoma, Puebla, Puebla, Mexico
  • Marco Octavio Cuadros Segovia
    Servicio de Oftalmología, Hospital Nacional Daniel Alcides Carrion, Lima, Peru
  • Sara Aurora Garcia y Otero Sánchez
    Research, Global Glaucoma Institute, Guadalajara, Jalisco, Mexico
  • Andrea Orozco Garcia
    Research, Global Glaucoma Institute, Guadalajara, Jalisco, Mexico
  • Isis Fernanda Vazquez
    Servicio de Oftalmología, Instituto Mexicano del Seguro Social Delegacion Coahuila, Piedras Negras, Coahuila, Mexico
  • Ana María Ponce Horta
    Research, Global Glaucoma Institute, Guadalajara, Jalisco, Mexico
  • Footnotes
    Commercial Relationships   Andrea Tornero-Jimenez None; Jose Paczka None; Montserrat Romo Sainz None; Yesenia Dorantes Diez None; Marco Cuadros Segovia None; Sara Aurora Garcia y Otero Sánchez None; Andrea Orozco Garcia None; Isis Vazquez None; Ana Ponce Horta None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4291. doi:
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      Andrea Tornero-Jimenez, Jose A Paczka, Montserrat Romo Sainz, Yesenia Yolanda Dorantes Diez, Marco Octavio Cuadros Segovia, Sara Aurora Garcia y Otero Sánchez, Andrea Orozco Garcia, Isis Fernanda Vazquez, Ana María Ponce Horta; One-year Surgical Outcomes of Eyes with Primary Congenital Glaucoma Treated with Combined Trabeculotomy-Trabeculectomy Supplemented with Mitomycin C.. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4291.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Due to an abnormal angle, primary congenital glaucoma (PCG) does not respond adequately to medical therapy and angle surgery is required as soon as it can be performed. Goniotomy and trabeculotomy are frequently used as primary angle procedures; however, combined trabeculotomy-trabeculectomy (CTT) supplemented either with or without mitomycin-C (MMC) is an option that might be more effective in the control of PCG. The aim of this study is to evaluate the one-year surgical outcomes of patients with PCG who underwent CTT-MMC in our center.

Methods : In this retrospective single-center study all medical records of children operated with a CTT-MMC in at least one eye as the first surgical procedure due to PCG were analyzed. All procedures were performed between January 2014-December 2020. We included 49 eyes of 49 patients which were assessed in terms of intraocular pressure (IOP), vision status (VS), number of antiglaucoma medications and presence of complications. Success after the procedure was defined either as a > 20% decrease in IOP from the preoperative period, or an IOP ≤ 21 mmHg without (complete) or with (qualified) glaucoma medication. For the statistical analysis, we randomly chose one eye of patients for bilateral PCG and the affected eye in unilateral PCG.

Results : The cohort included 49 consecutive PCG patients (27 female, 22 male; mean age 15.2 ± 12.3 months), of whom 34 (69.4%) underwent simultaneous bilateral CTT. The mean preoperative IOP was 39.5 ± 15.8 mmHg and 13.1 ± 4.2 mmHg at the last follow-up visit (p < 0.0001). Preoperatively, all 49 eyes were on ocular hypotensive medications. At the last follow-up visit, only 12 eyes (24.5%) required such therapy (p < 0.0001). Analysis revealed one-year overall and complete success rates of 87.8% (n=43) and 77.5% (n=38), respectively. Surgical failure was related preoperative corneal clarity and prior glaucoma surgery. Of the VS data at last follow-up (n=38, 77.5%), 31 eyes (81.6%) had improved or stable vision and 7 eyes (18.4%) had mild to moderate vision reduction with no blind eyes recognized during the follow up period. Post-operative complications were identified in 10 eyes (20.4%). All of them were mild, self-limited or resolved with minimal intervention.

Conclusions : Primary CTT-MMC seems to be an effective and safe surgical treatment after one year in PCG patients.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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