Combined trabeculotomy and trabeculectomy as an initial procedure in uncomplicated congenital glaucoma

Objective: To review the results of combined trabeculotomy and trabeculecto my as a primary procedure in congenital glaucoma. Methods: A retrospective review of 100 consecutive eyes in 60 children unde rgoing surgery from December 30, 1991,to April 17, 1996. Features at initia l examination, ie, corneal size and clarity, presence or absence of anterio r segment structural abnormalities, and intraocular pressure (IOP), were no ted. Data pertaining to perioperative use of mitomycin and the occurrence o f complications were collected. After surgery, all patients had IOP, cornea l integrity, and any postoperative complication recorded under chloral hydr ate sedation. Results: Mean preoperative IOP was 31 mm Hg. Average horizontal corneal dia meter was 12.60 mm. Ninety-five eyes had corneal opacification. Twenty-nine eyes had additional anterior segment anomalies, with ectropion uveae (n = 11), Peters anomaly (n = 9), and partial aniridia (n = 7) being the most co mmon. Mitomycin (0.2 or 0.4 mg/mL) was used in 87 eyes. Eleven eyes sustain ed hyphemas during or just after surgery. Total average follow-up was 304 d ays. Eyes iri which no coexistent anterior segment anomalies were present h ad a 78% (49 eyes) operative success (IOP, <21 mm Hg); however, in eyes wit h associated anterior segment anomalies, the success rate was much lower (4 5% [18 eyes]). The difference in success rates between both groups was stat istically significant (P = .03, chi(2) test). Conclusions: Primary combined trabeculotomy and trabeculectomy was a useful initial procedure in uncomplicated congenital glaucoma. This was particula rly true where corneal opacification, as in nearly all our eyes, precluded goniotomy; however, where other stigmata of anterior segment dysgenesis coe xisted, results were significantly poorer.