Long-term visual results following primary trabeculectomy for infantile glaucoma

Purpose: To report the long-term visual outcome of eyes that underwent primary trabeculectomy for infantile glaucoma and to evaluate factors that affect visual prognosis. Methods: Thirty-five eyes of 22 consecutive patients presenting between 1980 and 1995 were included. Visual acuity, visual fields and refractive status were assessed and patient records reviewed. Results. Nineteen of 22 patients (86.3%) achieved 6/12 or better, (21 of 35 eyes; 60%). Reasons for decreased vision included amblyopia (5 eyes), field loss (4 eyes), corneal opacification (2 eyes), and uncontrolled IOP (1 eye). Primary glaucoma had a better outcome than secondary glaucoma. Vision was frequently unequal despite controlled pressure, clear media and full fields in both eyes. This was associated with myopic anisometropia and apparent amblyopia. Ten patients responded to patching. Eyes with field defects were unresponsive to patching. Conclusions. Field defects, corneal scarring, marked anisometropia and severe astigmatism result in poor vision. Anisometropic amblyopia is frequently present and responds well to patching. Visual outcome is dependent on early and sustained control of intraocular pressure and aggressive treatment of amblyopia.