Outcomes in Primary Congenital Glaucoma, 2011-2023: L V Prasad Eye Institute, Hyderabad.

Abstract

Purpose: To report the clinical outcomes in patients with primary congenital glaucoma (PCG) managed over a period of 13 years.

Design: Retrospective cohort study.

Participants: One thousand one hundred fifty eyes of 704 patients undergoing surgery for PCG between January 2011 and December 2023 with a minimum follow-up of 6 months.

Methods: Medical records of children with PCG were reviewed, and demographic and clinical data were collected. Patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C (MMC) as an initial procedure were included (n = 1128 eyes). Complete success was defined as intraocular pressure (IOP) ≥ 6 mmHg and ≤ 16 mmHg without glaucoma medications and qualified success when 1 glaucoma medication was required. Failure was defined as uncontrolled IOP with more than 1 glaucoma medication, need for repeat surgery, chronic hypotony (IOP < 6 mmHg on 2 consecutive visits at 1 month interval) or any sight-threatening complications.

Main outcome measures: Intraocular pressure control, number of glaucoma medications, visual acuity (VA), and success rate.

Results: The mean age of patients at first surgery was 23.1 (standard deviation [SD]: 44.7) months (range, 9 days to 233 months; median, 5 months) and mean follow-up was 60.1 (SD: 49.6) months. Infantile-onset PCG was the most common form (61%) of presentation. Primary CTT without MMC was performed in 1128 eyes (98.1%). Complete success rate was 85.9%, 69.7%, and 37.8%, at the 1st, 5th, and 10th year, respectively. The corresponding complete plus qualified success rate was 98.2%, 93.3%, and 84.1%, respectively. Overall, infantile-onset PCG showed better success rates than other 2 groups. There was a significant reduction in IOP at last follow-up (43.4%; P < 0.0001). Preoperatively, majority of eyes (n = 937; 81.5%) were using glaucoma medications, whereas at last follow-up, 388 eyes (41.4%) required medications (P < 0.0001). Of the 690 eyes (60%) that presented with corneal edema, 622 eyes (90%) had clear cornea at last follow-up (P < 0.0001). At last follow-up, 190 eyes (23.1%) had VA of ≥20/40. Multivariate Cox proportional hazards analysis revealed level of IOP and corneal diameter to be independent risk factors for poor surgical outcome.

Conclusions: Our large cohort study treated by CTT without MMC is encouraging and may be considered as the initial surgical procedure in PCG. The outcomes were more favorable in children with infantile-onset PCG.

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.