Dlouhodobé výsledky chirurgické léčby jednostranného primárního kongenitálního a infantilního glaukomu

Overview

Aim: To evaluate the long-term outcomes of surgical treatment in unilateral primary congenital glaucoma (PCG), with a focus on stabilizing intraocular pressure (IOP) and structural and functional parameters of the affected eye.

Material and Methods: A retrospective analysis was performed on 20 eyes of 20 patients with unilateral PCG operated on between 2002–2022 by combined trabeculotomy-trabeculectomy (CTT) or trabeculectomy (TBE) with/without MMC at the Department of Pediatric Ophthalmology, University Hospital Brno. The evaluated parameters included age at the time of diagnosis and surgery, type and number of procedures, pre -⁠ and postoperative IOP, presence of buphthalmos and Haab’s striae, corneal diameter, cup-to-disc ratio (C/D), spherical equivalent (SE), best-corrected visual acuity (BCVA), use of medication, visual field findings, and retinal nerve fiber layer (RNFL) thickness on OCT. Surgical success was defined as IOP ≤ 21 mmHg without the need for further glaucoma surgery.

Results: Mean age at the time of diagnosis was 7.9 months, with 85% diagnosed before 6 months; mean period of follow-up monitoring was 12.3 years. CTT was performed in 55% and TBE in 45% of patients, with mean age at the time of surgery of 10 months. All eyes presented with buphthalmos and Haab’s striae; mean corneal diameter was 13.1 mm. The C/D ratio decreased from 0.53 to 0.26 (p = 0.002) and IOP from 30.1 to 14.7 mmHg (p < 0.0001). At the final follow-up examination, 85% of patients required no topical medication (mean 0.7; range 0–4). One additional procedure was needed in 10% of cases, with an overall primary surgical success rate of 90%. Mild to moderate myopia was the most common refractive outcome (65%). Mean BCVA was 0.6, with ≥ 0.5 achieved in 65% of patients. Mean RNFL thickness was 82.9 µm; significant thinning below 80 µm with corresponding visual field defects was observed in 3 eyes.

Conclusion: With early diagnosis and appropriate surgical treatment, unilateral PCG has a favorable long-term prognosis. CTT and TBE provide stable IOP control, partial reversal of glaucomatous cupping, and good visual function. Refractive correction, amblyopia prevention, and careful monitoring of the other eye are essential.

Keywords:

unilateral primary congenital glaucoma – combined trabeculotomy with trabeculectomy (CTT) – reversal of glaucomatous cupping