To estimate the long-term surgical and visual outcomes in patients with primary congenital glaucoma (PCG) who completed at least 20 years of follow-up.
Retrospective clinical database study.
Two hundred and twenty eyes of 121 patients operated for PCG between January 1991 and December 2000 and who returned for a follow-up visit from January 2021 through to January 2022.
Retrospective review of medical records of patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C as an initial procedure. Success was defined as complete when IOP was ≥6 mmHg and ≤21 mmHg without glaucoma medication and qualified when upto two glaucoma medications were required. Eyes needing reoperation for IOP control were considered as failures. A mixed effects model using maximum likelihood estimation was used in the estimation of eye-based variables and make comparisons between different visits. Kaplan-Meier survival analysis was used to estimate the probabilities of surgical and functional successes. Cox proportional-hazards regression using sandwich clustered estimation was used to evaluate risk factors for failure and poor visual outcome.
Primary outcome measure was proportion of patients who demonstrated complete success over 20-year follow-up. Secondary outcome measures included rate of surgical failure and need for reoperation for glaucoma, visual acuity, refractive errors, risk factors for poor outcome and complications.
Kaplan-Meier survival analysis revealed 1 year, 10 years, 20 years complete success rates of 90.7%, 78.9% and 44.5% , respectively. In univariate analysis, surgical failure was higher among patients with any additional intraocular surgery. However, none of the clinical parameters were associated significantly with failure in multivariate analysis. Overall, the proportion of eyes with good, fair and poor visual outcome was 33.2%, 16.4% and 50.4% , respectively. Myopia was seen in 68.9% eyes. Twenty-eight eyes of those who underwent primary CTT (14.4%) required second surgery for IOP control. There were no significant intraoperative complications. Six eyes required enucleation due to painful blind eye.
CTT is a useful procedure in this large cohort of patients with PCG. It provides good IOP control and moderate visual recovery that remained over a 20-year follow-up after surgery.

Copyright © 2023. Published by Elsevier Inc.