[Trabeculotomy as first-line surgical treatment in pediatric glaucoma: surgical and visual outcomes from a 7-year retrospective study]

Abstract

Introduction: Intraocular pressure and visual outcomes in primary pediatric glaucoma treated with trabeculotomy.

Materials et methods: All children undergoing trabeculotomy as first-line surgical treatment between January 2002 and January 2012 were included in a retrospective monocentric study. We report initial clinical features, surgical complications, ophthalmological outcome and clinical progression.

Results: Twenty-nine eyes of 16 children met the inclusion criteria and were treated with trabeculotomy as first-line treatment (mean age: 6 months). Median follow-up was 7 years. No major perioperative complications occurred, but minor complications were observed in 11 eyes. Mean pre-operative and initial post-operative intraocular pressures were 25.4 and 9.1mmHg respectively, thus a decrease of 16.3 points (63%). Overall surgical success rate was 89% at first follow-up, 72% at one year and 64% on last follow-up. A mean intraocular pressure of 15mmHg on no medications was achieved for two-thirds of eyes. After 7 years of follow-up, over 50% of eyes did not require a 2nd surgery. Visual acuity was at least 20/30 for 62% of eyes (83% for eyes requiring only trabeculotomy).

Discussion and conclusion: Trabeculotomy as first-line treatment of primary juvenile glaucoma is a safe and effective surgery in about two-thirds of cases. It allows pressure control and satisfactory visual outcome in the majority of children.

Keywords: Chirurgie du glaucome; Congenital glaucoma; Glaucoma surgery; Glaucome congénital; Trabeculotomy; Trabéculotomie.