Surgical Management of Primary Congenital Glaucoma: Results of a Nationwide Descriptive Study in France (CONGLAU).

Abstract

Purpose: Childhood glaucoma is rare but severe, with no recognized standard surgical procedure. We conducted a retrospective, observational, multicenter study describing surgical practices for primary congenital glaucoma (PCG) in France.

Patients and methods: This study was conducted between 2013 and 2018 using data from PCG patients aged <4 years at 16 reference centers in France. Intraocular pressure (IOP) (baseline [pre-surgery], 1 month, 1 year), initial surgical procedure, antimitotic (mitomycin C [MMC]) use, secondary intervention(s), and surgical success (complete, relative, or failure) were recorded.

Results: Overall, 116 eyes (83 patients) were included. The most common surgeries were trabeculotomy (31.0%) and trabeculotomy combined with trabeculectomy (20.7%). A further 11 other types of surgery were performed for <10% of eyes. Median IOP was reduced in each surgical group at 1 month (the largest median reduction being for combined trabeculotomy/non-perforating deep sclerectomy [-60%]) and at 1-year (the largest median reduction being for trabeculectomy [-55%]). Anti-glaucomatous treatment was administered in 30.4% of cases, most commonly for trabeculectomy (66.7%). Complete and relative surgical success were observed for 21.5% and 33.6% of surgical procedures overall, with complete success most common for trabeculotomy (47.1%). When MMC was used (51.8% of surgical procedures overall, excluding trabeculotomy), surgery was less successful (complete success 3.6% versus 40.8%) and further interventions were more common.

Conclusion: There was a trend towards better effectiveness of angle-based surgery (eg, trabeculotomy). The findings suggest that MMC may not be essential in first-line PCG surgery.