Outcomes after surgery for congenital glaucoma: the Five Year Experience at The University of Hong Kong

Abstract

Aims The purpose of this study was to determine the treatment efficacy for primary congenital glaucoma at the Department of Ophthalmology, University of Hong Kong over the recent 5 years. Methods A retrospective study was conducted using procedure codes to identify patients having the following procedures at Queen Mary Hospital of Hong Kong: goniotomy, trabeculotomy, trabeculectomy ab externo with or without mitomycin C, transcleral ciliary cyclophotocoagulation and glaucoma drainage implant. Other restrictions included an initial age range from 0 to 10 years and procedures done between January 2010 and January 2015. Patients with paucity of information, secondary glaucoma or with procedures for ocular abnormalities other than glaucoma were excluded from analysis. Preoperative data, operative procedure and postoperative data were collected. Criteria for surgical success included an intraocular pressure of less than 22 mmHg and no need for further surgery. Results A total of 5 pediatric patients with 9 eyes were diagnosed with primary congenital glaucoma and underwent surgical treatment during the study period. There were 2 girls and 3 boys. All but 1 patient had bilateral disease. Only 1 patient had other eye diseases in addition to primary congenital glaucoma. All 5 patients and 9 eyes were started on 3 topical glaucoma eyedrops (nonselective beta-blocker, prostaglandin analogue and carbonic anhydrase inhibitor) and oral acetazolamide preoperatively. 4 patients and 7 eyes underwent goniotomy as the primary procedure while 1 patient and 2 eyes underwent trabeculotomy as the primary procedure due to poor anterior chamber view. The average age on day of operation was 106 (range 13 – 365) days after birth. Mean preoperative intraocular pressure was 25.4 mmHg (10.9). Surgical success was noted in 3 out of 5 patients, with one patient requiring additional goniotomy in both eyes and another patient requiring additional trabeculotomy and then further trabeculectomy with mitomycin C in both eyes. Conclusion In this study, surgical intervention for congenital glaucoma achieved high success rates, with most patients requiring a single procedure for each eye to achieve disease stability. However the study is limited by its retrospective nature and small sample size. A continued audit of surgical outcomes at will provide quality assurance.