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 < 0.001, p < 0.001 and p = 0.001 respectively). The mean ± standard deviation best corrected visual acuity (BCVA) was 0.44 ± 0.3 decimal. The BCVA inter-eye difference was >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.