Trabeculotomy for primary congenital glaucoma

Srishti Raj

Purpose: To report results of trabeculotomy as an initial procedure in primary congenital glaucoma in north Indian population.

Design : Retrospective analysis of primary congenital glaucoma cases who underwent trabeculotomy as primary procedure.

Methods : a total of 111 eyes of 67 patients underwent trabeculotomy under general anaesthesia as a primary procedure for primary congenital glaucoma in chlldren ≤ 1year age. 94 eyes of 55 patients had a minimum follow up of 6 months. Main outcome measures were preoperative and postoperative intraocular pressure control, corneal size , cornea clarity, and refractive error.

Results: The mean age was 3.83 ± 3.29 months ( range : 5 days – 12months). 43 ( 78.2%) patients were ≤ 6 months and 12( 21.8%) patients were between 6-12 months age. Males were twice as common than female :: 37 : 18 (2:1). . 38/55 (68.8%) had bilateral disease and 17/55(32.2%) were unilateral . Chief presentations were white opacity 24/55(47.27%), large eyes 16/55 (29.9%), watering 15/55 (27.2%), two patient had photophobia and four were referred from outside as a diagnosed case of primary congenital glaucoma . Principle signs were Haab's striae in 33 patients, cornea clouding 19 patients and corneal opacity in 21 patients. Final diagnosis was primary congenital glaucoma in 50 patients, aniridia in 4 patients , Peter's anomaly & Axenfield anomaly in one patient each. Preoperative and postoperative Iop was 20 ( range 4-41) and 16.18 (8-32) under general anaesthesia at 6 months follow up. There was insignificant change I preoperative and postoperative corneal diameter, IOP was controlled (≤16mmHg) with up to 2 antiglaucoma medications in 90% of cases. Additional procedures done were, trabeculectomy in 8 patients, Ahmed glaucoma valve in one patient optical penetrating keratoplasty in one patient and cataract extraction with PCIOL in one patient.

Conclusions : Trabeculotomy alone is able to control IOP in most cases of Primary congenital glaucoma.