Nonpenetrating external trabeculectomy for congenital glaucoma: a retrospective study.

Cameron Parsa // Publications // Nov 01 2007

PubMed ID: 17980742

Author(s): Roche O, Beby F, Parsa A, Orssaud C, Dufier JL, Parsa CF. Nonpenetrating external trabeculectomy for congenital glaucoma: a retrospective study. Ophthalmology. 2007 Nov;114(11):1994-9. PMID 17980742

Journal: Ophthalmology, Volume 114, Issue 11, Nov 2007

OBJECTIVE To evaluate the results of nonpenetrating external trabeculectomy (NPET) for primary congenital glaucoma (CG).

DESIGN Retrospective, noncomparative, interventional case series.

PARTICIPANTS Forty-three eyes of 27 consecutive patients with primary CG.

METHODS Initial intent of NPET with intraoperative conversion to trabeculectomy in cases where aqueous humor outflow was deemed insufficient or where Schlemm’s canal appeared to be absent.

MAIN OUTCOME MEASURES Intraocular pressure (IOP). Success was defined as an IOP less than 12.5 mmHg at 1 year after the procedure or later, using adjunctive pressure-lowering topical medications whenever needed.

RESULTS Mean initial measures of IOP were 18.8 mmHg. Of the 43 eyes, a total of 13 required conversion to trabeculectomy: 9 because of insufficient filtration, 3 because of an apparent absence of Schlemm’s canal, and 1 because of accidental perforation. Of these 13 eyes that ultimately underwent trabeculectomy, 11 achieved successful IOP control, 3 in association with topical therapy. In 1 eye, a retinal detachment developed, and in 7 eyes, other complications were observed. Among the 30 remaining eyes that underwent NPET, 2 underwent the procedure twice, and 1 eye underwent the procedure 3 times. Postoperative complications were not noted in this NPET-only group. Mean postoperative IOP was 10.8 mmHg, with final IOP controlled in 28 of the 30 eyes (93%; P<0.0001), occasionally after repeat surgeries and in combination with topical therapy.

CONCLUSIONS Nonpenetrating external trabeculectomy may be considered as an initial procedure for some cases of primary CG. It appears to be an alternative to trabeculectomy with fewer risks of postoperative complications.