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. 1999 Mar;83(3):317–322. doi: 10.1136/bjo.83.3.317

Prognosis of primary ab externo surgery for primary congenital glaucoma

T Dietlein 1, P Jacobi 1, G Krieglstein 1
PMCID: PMC1722973  PMID: 10365040

Abstract

BACKGROUND—The strategy of pressure reducing surgery in primary congenital glaucoma has changed over the last decade. Ab externo filtering procedures—for example, trabeculectomy or trabeculotomy combined with trabeculectomy, have now been accepted even as primary intervention.
METHODS—The authors reviewed 61 eyes in 35 consecutive patients with primary congenital glaucoma, who underwent different types of initial ab externo surgery between 1988 and 1996 (median follow up 36 months) to determine the efficacy of different surgical techniques and the influence of various risk factors.
RESULTS—Trabeculotomy was performed in 17 eyes (27.9%), trabeculotomy with trabeculectomy in 15 eyes (24.6%), and trabeculectomy in 29 eyes (47.5%). Regarding age, preoperative intraocular pressure, corneal diameter, ocular axial length, and incidence of corneal haze the subgroups were comparable. Success rates of trabeculotomy, trabeculectomy, and a combined procedure did not significantly differ when assessed by life table analysis. Patient age under 3 months (p=0.014) and an ocular axial length of 24 mm or more (p=0.016) proved to be major risk factors for primary ab externo surgery failure. A second operation was necessary in 20 of 61 eyes (32.8%) during follow up.
CONCLUSION—Prognosis of primary ab externo glaucoma surgery in primary congenital glaucoma seems to be governed more by the individual course and severity of the disease than by modification of surgical techniques.

 Keywords: primary congenital glaucoma; trabeculotomy; trabeculectomy; glaucoma surgery

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Figure 1  .

Figure 1  

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Graph demonstrating a change in surgical techniques of ab externo surgery performed in primary congenital glaucoma during the past decade in our department.

Figure 2  .

Figure 2  

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Censored subjects appear as data points in the flat part of the survival curve, the error bars (below) show the standard error of survival. Kaplan-Meier curve of censored survival data shows no significant difference in outcome between trabeculotomy, trabeculectomy, and combined procedure.

Figure 3  .

Figure 3  

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Censored subjects appear as data points in the flat part of the survival curve, the error bars (below) show the standard error of survival. Kaplan-Meier curve of censored survival data of primary trabeculectomy differs significantly from secondary filtering interventions (p=0.02).

Figure 4  .

Figure 4  

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Censored subjects appear as data points in the flat part of the survival curve, the error bars (below) show the standard error of survival. Ab externo surgery in patients aged younger than 3 months show poorer outcome than in older patients (p=0.014).

Figure 5  .

Figure 5  

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Censored subjects appear as data points in the flat part of the survival curve, the error bars (below) show the standard error of survival. Ab externo surgery of eyes with myopic axial length likewise show significantly (p=0.016) worse results than eyes with axial length <24 mm.

Selected References

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