OBJECTIVE: To report on the outcome of subsequent interventions after failed initial intervention for primary congenital glaucoma (PCG).
METHODS: Retrospective chart review of children presenting with PCG and failed the initial glaucoma surgery in Alexandria Main University Hospital from 2005 to 2017. The data included demographics, preoperative, operative and postoperative clinical characteristics. Success was defined as IOP<16mmHg and <20% from the presenting IOP and C/D ratio like or better than presentation.
RESULTS: The charts of 531 (260 right, 49%) eyes of 360 (224 males, 62%) children presenting with PCG and failed the initial glaucoma surgery (58 [31 right, 53%] eyes [10.9%] of 50 [28 males, 56%] children) revealed that at initial presentation, the mean±standard deviation (range, median) of the age of the children subjected to one successful glaucoma procedure and the study children was 8.6±11.7 (0.6-109, 5.2) and 4.9±6.1 (0.5-34.4, 3.0) months, respectively. Each of the study eyes was subjected to 2.6±0.8 (2-5.2) glaucoma procedures. The mean±standard deviation (range, median) duration between the initial and second glaucoma surgery and the duration of follow-up was 6.9±7.8 (0.7-39,3.9) and 61.5±32.1 (12.0-139.1, 60.1) months, respectively. At the final follow-up visit success was reported in 41 (70.1%) eyes by IOP<16mmHg criterion, 39 (67.2%) eyes by IOP>20% reduction criterion and in 28 (out of 35 eyes, 80.0%) by the optic nerve condition (C/D ratio) criterion. Success by all 3 criteria was reported in 25 (out of 35 eyes, 71%) eyes.
CONCLUSIONS: A repeat glaucoma surgical procedure maybe needed in up to 11% of operated PCG eyes, with the subsequent glaucoma surgical procedures being successful by about 70%.

OBJECTIVE: To report the outcome of combined trabeculotomy-trabeculectomy among children with primary congenital glaucoma at a child eye health tertiary facility in southwest Nigeria.
METHODS: A retrospective review of children who underwent combined trabeculotomy-trabeculectomy (CTT) surgery on account of primary congenital glaucoma between 2016 and 2020 at the University College Hospital, Ibadan, Nigeria. All surgeries were performed by paediatric ophthalmologists. The main outcome measures were postoperative intraocular pressure, corneal clarity, and complications.
RESULTS: A total of 21 eyes of 13 patients were included. Ten (76.9%) of the patients were males and 8 (61.5%) had bilateral disease. The mean age at presentation was 4.8 (± 3.6) months, while the mean age at surgery was 8.1 (± 5.9) months. The average waiting time between noticing symptoms and presenting to the clinic was 3.2 (±4.9) months. The mean horizontal corneal diameter was 13.2 (± 1.4) mm, while the mean pre-operative intraocular pressure (IOP) was 25.7 (± 8.6) mmHg. The surgical success (IOP<21 mmHg) rates at 3, 6, and 12 months were 86.7%, 64.3%, and 92.9% respectively. The Kaplan-Meier estimates of the probability that IOP remained below 21 mmHg up till 3, 6, and 12 months were 74%, 53%, and 53% respectively. Postoperatively, 85.7% of the eyes had complete resolution of corneal oedema. One eye had an intraoperative complication of vitreous loss. The post-operative clinic follow-up rate reduced to 52.4% by 1 year.
CONCLUSIONS: Combined trabeculotomy-trabeculectomy is a relatively safe procedure that is associated with favorable success in Nigerian children with primary congenital glaucoma.
OBJECTIVE: Présenter le résultat de la combinaison de la trabeculotomie et la trabeculectomie chez les enfants atteints de glaucome congénital primitif dans un hôpital tertiaire du sud-ouest du Nigéria.
METHODS: Une revue rétrospective des enfants qui avaient subi une combinaison de trabeculotomie et trabeculectomie pour le traitement de glaucome congénital primitif entre 2016 et 2020 à l’University College Hospital,Ibadan, Nigeria. Toutes les chirurgies avaient été effectuées par des ophtalmologistes pédiatres. Les principaux résultats étaient la pression intraoculaire postopératoire, la clarté cornéenne et les complications.
RESULTS: Au total 21 yeux de 13 patients étaient étudiés. Dix (76,9%) patients étaient des garçons et 8 (61,5%) avaient une atteinte bilatérale. La moyenne d’age à la présentation était de 4,8 (± 3,6) mois, tandis que la moyenne d’age au moment de la chirurgie était de 8,1 (± 5,9) mois. Le temps d’attente moyen entre l’observation des symptômes et la présentation à la consultation était de 3,2 (± 4,9) mois. Le diamètre cornéen horizontal moyen était de 13,2 (± 1,4) mm, tandis que la pression intraoculaire (PIO) préopératoire moyen était de 25,7 (± 8,6) mmHg. Les taux de succès chirurgical (PIO <21 mmHg) à 3, 6 et 12 mois étaient respectivement de 86,7%, 64,3% et 92,9% . Les estimations de Kaplan-Meier de la probabilité que la PIO restait en dessous de 21 mmHg jusqu’à 3, 6 et 12 mois était respectivement 74%, 53% et 53%. Après l’opération, 85,7% des yeux avaient une résolution complète de l’œdème cornéen. Un œil avait une complication peropératoire de perte de vitré. Le taux de visites médicales en postopératoire était réduit à 52,4% en 1 an.
CONCLUSIONS: La combinaison de la trabeculotomie et de la trabeculectomie est une procedure chirurgicale relativement sûre associée à un succès favorable chez les enfants Nigérians atteints de glaucome congénital primitif.
UNASSIGNED: Glaucome congenital, Trabeculotomie et Trabeculectomie, Résultat chirurgical, Pression intraoculaire.

BACKGROUND: Primary congenital glaucoma (PCG) is the most common type of glaucoma in pediatric patients. The aim of this study was to compare the effectiveness of combined trabeculotomy-trabeculectomy versus Ahmed valve implantation for cases of PCG refractory to traditional incisional angle surgery (goniotomy and trabeculotomy) in the Egyptian population.
METHODS: The study was conducted in the Glaucoma Clinic of the Research Institute of Ophthalmology (Egypt). The study included 66 eyes of 66 patients (in two groups) with advanced PCG who had previous failed goniotomy, trabeculotomy, or both. Group 1 included 33 patients who underwent trabeculotomy-trabeculectomy procedures; group 2 included 33 patients who underwent FP 8 Ahmed valve implantation. The main outcome measures were intraocular pressure (IOP) reduction, corneal diameter, and axial length stability in both groups. Secondary outcome measures included detection of complications in both groups.
RESULTS: The average ages of the patients were 13.5 ± 3.9 months and 15.3 ± 5.8 months in groups 1 and 2, respectively. Ten patients (30.3%) in group 1 and 9 patients (27.3%) in group 2 had family histories of PCG. Positive consanguinity was present in 26 patients (78.8%) in group 1 and in 27 patients (81.8%) in group 2. In group 1, the mean intraocular pressure (IOP) value decreased from 33.6 ± 3.4 mmHg preoperatively to 13.8 ± 0.6, 16.9 ± 1.5, 18.2 ± 2.5, 19.8 ± 3.6, and 20.2 ± 3.1 mmHg in the first postoperative month and after years 1, 2, 3, and 4, respectively (p < 0.001). In group 2, the mean IOP value decreased from 33.4 ± 4.5 mmHg preoperatively to 13.3 ± 1.1, 16.3 ± 1.6, 18.1 ± 1.0, 19.1 ± 3.5, and 19.9 ± 3.7 mmHg in the first postoperative month and after years 1, 2, 3, and 4, respectively (p < 0.001). The average number of medications decreased from 2.2 ± 0.4 preoperatively to 1.8 ± 0.4 postoperatively in group 1, while it decreased from 2.1 ± 0.4 preoperatively to 1.9 ± 0.3 postoperatively in group 2. The success rate in group 1 was 97, 91, 76, and 61% in years 1, 2, 3, and 4, respectively, whereas the success rate in group 2 was 97, 93, 81, and 66% in years 1, 2, 3, and 4, respectively.
CONCLUSIONS: Both procedures, i.e., combined trabeculotomy-trabeculectomy and Ahmed valve implantation are suitable options in advanced PCG with failed trabeculotomy and goniotomy. Ahmed valve implanation has a better long-term survival, but trabeculotomy-trabeculectomy provides a second chance for surgical intervention.