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Submitted: 2023-11-14
DOI: 10.35119/myjo.v7i1.402
Original Articles
Published: 2025-07-15

Surgical outcome of trabeculotomy in congenital glaucoma patients in a tertiary hospital in Malaysia

Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia
Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
buphthalmos congenital glaucoma goniotomy trabeculotomy

Abstract

English 

Purpose: To evaluate the surgical success rate of trabeculotomy in congenital glaucoma patients.

Study design: Retrospective observational study.

Methods: A total of 44 eyes of 26 patients with congenital glaucoma, either primary or secondary causes, who underwent trabeculotomy in Hospital Kuala Lumpur between January 2012 and July 2019 were retrospectively studied. Preoperative and postoperative intraocular pressure (IOP), corneal clarity and diameter, optic disc cupping, visual acuity and postoperative refractive error, success rate and complications were evaluated. Kaplan-Meier survival analysis was applied to evaluate surgical success rate at 1 year and 2 years postoperative.

Results: Twenty-seven (61.4%) eyes were diagnosed as primary congenital glaucoma, and 17 (38.6%) eyes were secondary glaucoma. The median age at the time of trabeculotomy was 3.9 months (IQR: 4.5 months). The cumulative surgical success rate at 1 year and 2 years postoperative was 72.7% and 50%, respectively. At final visit, the mean IOP was significantly reduced from 32.8 ± 12 mmHg to 18.2 ± 8.3 mmHg (p<0.001). Mean number of antiglaucoma medication was also reduced from 1.6 ± 1.2 to 0.9 ± 1.0 (p=0.001), with 21 (47.7%) eyes were free of medication. Mean best corrected visual acuity was improved from 2.6 ± 0.5 to 1.3 ± 1.0 LogMAR (p<0.001). There was no severe intraoperative or postoperative complication seen. At 2 years follow-up, 5 (11.4%) eyes developed glaucomatous optic neuropathy and 10 (22.7%) eyes developed high myopia.

Conclusions: Trabeculotomy is a successful surgery for congenital glaucoma patients with a low complication rate.

 

Bahasa Malaysia

Tujuan: Menilai kadar kejayaan pembedahan trabekulotomi pada pesakit glaukoma kongenital.

Reka bentuk kajian: Kajian retrospektif pemerhatian.

Kaedah: Sejumlah 44 mata daripada 26 pesakit dengan glaukoma kongenital, sama ada punca asal atau punca sekunder, yang menjalani trabekulotomi di Hospital Kuala Lumpur antara Januari 2012 dan Julai 2019 dikaji secara retrospektif. Tekanan intraokular praoperasi dan posoperasi (TIO), kejernihan dan diameter kornea, cupping cakera optik, ketajaman visual dan ralat pembiasan posoperasi, kadar kejayaan dan komplikasi dievaluasi. Analisis kelayakan hidup Kaplan-Meier digunakan untuk menilai kadar kejayaan pembedahan pada 1 tahun dan 2 tahun selepas pembedahan.

Keputusan: Dua puluh tujuh (61.4%) mata didiagnosis sebagai glaukoma kongenital asas, manakala 17 (38.6%) mata adalah glaukoma sekunder. Usia median semasa trabekulotomi adalah 3.9 bulan (IQR: 4.5 bulan). Kadar kejayaan pembedahan kumulatif pada 1 tahun dan 2 tahun selepas pembedahan adalah 72.7% dan 50% masing-masing. Pada lawatan akhir, purata TIO telah berkurang secara signifikan dari 32.8 ± 12 mmHg kepada 18.2 ± 8.3 mmHg (p<0.001). Purata bilangan ubat anti-glaukoma juga berkurang dari 1.6 ± 1.2 kepada 0.9 ± 1.0 (p=0.001), dengan 21 (47.7%) mata bebas daripada ubat. Purata ketajaman visual terbaik diperbetulkan telah meningkat dari 2.6 ± 0.5 kepada 1.3 ± 1.0 LogMAR (p<0.001). Tiada komplikasi intraoperatif atau posoperatif yang teruk diperhatikan. Selepas 2 tahun pemeriksaan, 5 (11.4%) mata mengalami neuropati optik glaukoma dan 10 (22.7%) mata mengalami miopia tinggi.

Kesimpulan: Trabekulotomi merupakan pembedahan yang berjaya untuk pesakit glaukoma kongenital dengan kadar komplikasi yang rendah.