Abstract
THE OUTCOME OF COMBINED TRABECULOTOMY AND TRABECULECTOMY IN THE TREATMENT OF PRIMARY CONGENITAL GLAUCOMA

Ahmed E. Khatatbeh, MD*, Hiba M. Khraisat, MD*, Mohammad E. Shihan, MD*, Fawaz H. Al Zwaimel, MD*, Nancy K. Al Raggad, MD*

ABSTRACT

Aim: to evaluate the efficacy of combined Trabeculotomy and Trabeculectomy procedure as an initial surgical intervention in primary congenital glaucoma to compare the results with that of primary trabeculotomy procedure. Method: This retrospective was conducted at king Hussein Medical Centre. All patients who underwent CCT for PCG between 2007 and 2016 were included in the study. Patients who lost follow up within the first year post operatively, patients who underwent more than one surgical procedure and patients with corneal haziness that prevented optic disc evaluation for cupping were excluded from the study. Patients were divided randomly into two groups; Group A includes those who underwent primary trabeculotomy alone and group B are those who underwent combined Trabeculotomy and Trabeculectomy. The outcome of eye examination which included assessment of Visual acuity, corneal haziness, intra ocular pressure (IOP) measurement and optic disc cupping were recorded prior to surgical intervention and post operatively. The results were analyzed and compared. Surgery was assumed to be successful when the IOP was less than 20mmHg post operatively without any anti glaucoma medications and there was no progression of optic disc cupping and no development of corneal haziness. Results: sixty patients with PCG were included in the study. 70% of patients were males (ratio 2.3:1). The disease was bilateral in 43 patients (71.7%) and in unilateral cases the right and left eyes were equally affected (ratio 1:1). The mean cup disc ratio (CD) was 0.75 in group A and 7.4 in group B preoperatively. Post operatively the main CD ratio was 0.55 in group A and 4.7 in group B. The mean age at which surgery was performed for eyes that showed reduction of CD ratio was 6.9 months in group A and 7.2 months in group B compared with23 and 21 months for the remaining patients with no reduction in cupping in group A and B respectively. Conclusion: Combined trabeculotomy and trabeculectomy was superior to primary trabeculotomy as an initial surgical intervention in the management of primary congenital glaucoma with better control of intra ocular pressure and more improvement in cup disc ratio. The surgery has to be performed as early as possible to gain an improvement of cup disc ratio.

Keywords: Primary congenital glaucoma, primary Trabeculotomy, Combined Trabeculotomy and Trabeculectomy.


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