Result of Trabeculotomy for Developmental Glaucoma as a Primary Surgical Procedure

Kim, Tae Woo; Lim, Key Hwan; Yu, Young Suk

Abstract

Developmental glaucoma is essentially a surgical disease, with goniotomy or trabeculotomy recommended as a primary surgical procedure. Although the success rates of both procedure are similar, trabeculotomy can be performed in eyes of with a hazy cornea, whereas a clear cornea is necessary to perform a goniotomy. To inspect the clinical results after primary trabeculotomy and find out the factors that have an influence on the outcome of surgery, we reviewed 40 consecutive eyes of 26 patients with developmental glaucoma who had underwent trabeculotomy as a primary surgical procedure. Preoperative intraocular pressure (IOP), corneal diameter, C/D ratio was compared to postoperative values and the cumulative success probability was calculated, with defining the success as the case where the IOP has been maintained equal to or less than 21mmHg after surgery without no enlargement in corneal diameter or progression of cupping of the optic disc. IOP was reduced by 18.7% after surgery and this change was statistically significant (p<0.01). However, there were no significant changes from the preoperative value in corneal diameter and C/D ratio. The cumulative success probability were 82.3% and 49.0% at 6 month and 1 year, respectively. Corneal opacity seemed to influence the outcome adversely with the 1 year cumulative success rate of 90.0% in the cases without corneal opacity and 37.6% in the cases with corneal opacity (p<0.05), whereas the type of glaucoma, age at the time of surgery, corneal opacity, preoperative IOP, corneal diameter, and C/D ratio appeared to make no differences on the outcome. In conclusion, trabeculotomy reduced the IOP effectively, but the success rate was significantly lower in eyes with corneal opacity. Therefore, investigations to find a better surgical treatment modality for the developmental glaucoma with corneal opacity will be needed.