Trabeculotomy in Primary Congenital Glaucoma

Abstract

Purpose: To evaluate outcome and frequency of complications involved in
Trabeculotomy in pediatric patients.
Material and Methods: A total of 10 children were enrolled from Pediatric
Ophthalmology Clinic, Bolan Medical College, Quetta during month of January
and February 2013. Only Primary Congenital Glaucoma (PCG) patients were
registered. Every patient had complete ocular examination under general
anesthesia including anterior segment examination, measurement of intraocular
pressure, corneal diameter, gonioscopy, axial lengths, fundoscopy and
retinoscopy where possible. The success criteria was defined as: Intraocular
pressure bellow < 15 mm Hg (under general anesthesia), simultaneous absence
of cup: disc ratio progression, disproportional enlargement of cornea and
stoppage or reduction in enhancement of axial length. Follow up period
comprised of one, two, four & eight months respectively.
Results: Ten patients under went trabeculotomy. Their mean age at the time of
surgery was 15 months (range 10-29 months). The IOP was successfully
controlled in 8 patients (80%). The pre-operative measurement was as follow:
IOP 30 mm Hg (±5.7), horizontal corneal diameter 13.06 mm (±0.6), axial length
21.9 mm (±0.8), CDR was 0.52 (0.23). The final reading of various parameters
was as under: IOP measured under GA 12 mm Hg, horizontal corneal diameter
13.0 mm (±0.5), Axial length 20.9 mm (0.6) and CDR was 0.3 (±0.21). 8 patients
(80%) had successful surgery while 2 patients (20%) had unsuccessful surgery.
4 (40%) patients had complications comprising of false passage, Iris prolapse,
stripes in descement‘s membrane and hyphaema.
Conclusion: Trabeculotomy is highly successful procedure in primary congenital
glaucoma. The complications observed were quite few in number. Distorted
limbal anatomy of Buphthalmic eyes may affect prognosis of surgery. Some of
the steps of trabeculotomy are similar to trabeculectomy.
Key words: Trabeculotomy, Congenital glaucoma, Buphthalmos.