SURGICAL RESULTS OF COMBINED TRABECULOTOMY-TRABECULECTOMY FOR DEVELOPMENTAL GLAUCOMA

Objective: The purpose of the study was to evaluate the surgical outco me of combined trabeculotomy-trabeculectomy in different types of prim ary developmental glaucomas. Design: A retrospective review of all cas es of primary developmental glaucomas that underwent primary combined trabeculotomy-trabeculectomy between August 1990 and September 1995, w ith a minimum follow-up of 6 months, was performed. Participants: One hundred and eighty-two eyes of 120 patients were included in this stud y; 122 (67%) eyes had congenital glaucoma; 22 (12.1%) eyes had infanti le glaucoma; and 38 (20.9%) eyes had juvenile glaucoma. Intervention: Primary combined trabeculotomy-trabeculectomy was the chosen intervent ion. Main Outcome Measures: Preoperative and postoperative intraocular pressures, visual acuities, success rate, corneal clarity and diamete rs, bleb characteristics, time of surgical failure, and complications were the main outcome measures. Results: Intraocular pressure (mean +/ - SD) reduced from a preoperative level of 26.5 +/- 8.3 mmHg; 30.3 +/- 9.9 mmHg; and 31.8 +/- 11.5 mmHg to 13.1 +/- 5.8 mmHg; 13.7 +/- 4.4 m mHg; and 13.3 +/- 6.0 mmHg in the congenital, infantile, and juvenile types of developmental glaucomas, respectively. Kaplan-Meier survival analysis showed that the success probability at 6 months was 94.4% +/- 2.3%; 90.9% +/- 6.1%; and 81.0% +/- 7.3% in the three groups, respect ively. The success probability of patients with juvenile glaucoma was significantly lower than it was for those with congenital glaucoma (P = 0.0393). Of 182 eyes, 105 (57.7%) eyes had corneal edema at presenta tion. Eighty-one (79%) of 105 eyes had complete clearance of corneal e dema postoperatively (P < 0.0001), The follow-up period ranged from 6 months to 48 months (mean, 10.7 +/- 12.0 months). There were no sight- threatening intraoperative and postoperative complications in any pati ent. Conclusions: Primary combined trabeculotomy-trabeculectomy is saf e, effective, and sufficiently predictable to be considered the first choice of surgical treatment in primary congenital glaucoma with corne al edema. Juvenile glaucoma has the worst prognosis, and infantile gla ucoma has a better prognosis than does juvenile glaucoma.