Clinical Study
Eye (2006) 20, 135–143. doi:10.1038/sj.eye.6701817; published online 8 April 2005
Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14 mm or more
Presented as a poster at the annual meeting of the American Academy of Ophthalmology, Anaheim, California, November 15–18, 2003.
Supported in part by the Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India.
The authors have no proprietary interest in any of the materials or techniques used in this study.
A K Mandal1, J H Matalia1, R Nutheti2 and S Krishnaiah2
- 1Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India
- 2International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
Correspondence: AK Mandal, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, LV Prasad Marg, Banjara Hills, Hyderabad –500034, AP, India. Tel: +91 40 23608262; Fax: +91 40 23548271. E-mail: mandal@lvpei.org
Received 4 November 2004; Revised 6 November 2004; Accepted 6 November 2004; Published online 8 April 2005.
Abstract
Purpose
To report the safety and efficacy of combined trabeculotomy and trabeculectomy (CTT) in advanced primary developmental glaucoma with corneal diameter 14 mm or more.
Patients and Methods
A total of 74 (121 eyes) consecutive patients aged 3 days–100 months (median, 10 months) with advanced developmental glaucoma were included. Primary CTT was performed by a single surgeon at a tertiary eye care centre in India over a 13-year period. The main outcome measures were changes in and final levels of intraocular pressure (IOP), corneal clarity, visual acuity, and refractive status.
Results
Mean preoperative IOP was 29.4
7.6 mmHg (range, 10–56 mmHg) and mean postoperative IOP was 15.56.6 mmHg (range, 6–38 mmHg) (P<0.0001) with percentage reduction of 44.527.1. Kaplan–Meier survival analysis revealed 3-, 6-, 9-, 12-, 24-, 48-, and 72-month success rates of 86.5, 80.5, 78.1, 75.5, 71.1, and 60.5%, respectively. Majority (80.5%) of the patients were myopes with mean spherical equivalent of 5.84.5D (range, 0.75–22.0D). Using various age-appropriate testing procedures, at the final follow-up visit, 14 patients (41.2%) had age-appropriate normal visual acuity and 20 patients (58.8%) had subnormal visual acuity. Best-spectacle-corrected visual acuity of 
20/60 was achieved in seven patients (26.9%). There were no sight-threatening intraoperative and postoperative complications.
Conclusion
CTT is safe and effective in patients with advanced primary developmental glaucoma. It offers good IOP control with a low complication rate, with about one-third of patients achieving a visual acuity of 20/60 or better.
Keywords:
developmental glaucoma, trabeculotomy, trabeculectomy, combined trabeculotomy and trabeculectomy, corneal diameter, outcome of surgery
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