Long-term results of combined viscotrabeculotomy-trabeculectomy in refractory developmental glaucoma

Background To evaluate the outcomes of combined viscotrabeculotomy-trabeculectomy in patients with refractory developmental glaucoma and to compare the success and complication rates with classical trabeculotomy-trabeculectomy procedure. Patients and Methods Patients who were selected for this study had cloudy corneas with a diameter of 13 mm or greater and with an initial intraocular pressure (IOP) of 27 mm Hg or more, and they were divided into two groups. Group 1 consisted of 40 eyes of 24 patients who had undergone combined viscotrabeculotomy-trabeculectomy with a mean follow-up time of 55.6 +/- 18.4 months, and group 2 consisted of 35 eyes of 20 patients who had undergone classical trabeculotomy-trabeculectomy with a mean follow-up time of 57.2 +/- 19.0 months. Pre- and postoperative IOPs, mean antiglaucoma medication, mean corneal diameter, success rates, intra-and postoperative complications were compared between two groups. Results Mean IOP reduced from a preoperative level of 33.2 +/- 5.3 and 32.8 mm Hg to 14.2 +/- 3.1 and 15.3 +/- 3.3 in group 1 and group 2, respectively (P < 0.001). The mean number of antiglaucoma medications used after surgery was significantly lower in group 1 (P < 0.05). Kaplan-Meier survival analysis showed that the success probability at the last visits was 90 and 71.4% in group 1 and group 2, respectively, and the difference was statistically significant (P = 0.01). The most common early postoperative complication was transient IOP elevation in group 1 and hyphema in group 2 (for each, P < 0.001). Conclusion Use of viscoelastic materials during trabeculotomy-trabeculectomy may increase the success rate of the procedure by prevention of postoperative hemorrhage, anterior chamber shallowing, adhesion of the incision lips or fibroblastic proliferation. Eye (2010) 24, 613-618; doi:10.1038/eye.2009.185; published online 4 September 2009