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  • Surgery for Primary Congenital Glaucoma Results in Sustained IOP Control

    By Stephanie Leveene, ELS
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, November 2023

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    In children with primary congenital glaucoma (PCG), the most common form of primary childhood glaucoma, vision can be saved if surgery is performed early. To understand the long-term surgical outcomes of differ­ent PCG subtypes, Mandal et al. conducted a retrospec­tive study using database information for 121 children (220 eyes) who underwent glaucoma surgery at a single clinic in India during a 10-year period. Twenty years after surgery, more than 43% of patients continued to have lower IOP, with better long-term outcomes related to undergoing surgery as a neonate rather than as an older infant or later.

    All patients in the study had surgery within one week of confirmed PCG diagnosis. Combined trabeculotomy–trabeculectomy (CTT) without mitomycin-C was performed in most cases, although trabeculectomy alone (n = 19) or transscleral cyclophotocoagulation in some patients with refractory glau­coma (n = 5) also was performed. Sur­gical success was defined as IOP of <16 mm Hg when the patient was under anesthesia and <21 mm Hg when the patient was in the office. Complete sur­gical success was defined as controlled IOP without need for a second surgery or glaucoma medication.

     One year after surgery, complete surgical success had been achieved in 89.1% of patients, which declined to 76.8% by 10 years and 43.1% by 20 years. For those with primary CTT as the main surgery, rates of complete surgical success were 90.7%, 78.9%, and 44.5% by one, 10, and 20 years, re­spectively. At the 20-year follow-up, the rate of complete success was highest for patients who had surgery as neo­nates, compared with those who had surgery later. A multivariate analysis showed that poorer long-term outcomes were associated with having additional nonglaucoma intra­ocular surgeries (hazard ratio, 2.41).

    The authors concluded that earlier surgeries produce sustained positive visual outcomes in patients who had PCG as children, with a slightly higher success rate for CTT. They noted that surgery provided good long-term IOP control, a fact that should be “encouraging for parents of children with PCG who are considering whether their children should undergo the procedure.”

    The original article can be found here.