The Effect Of Modified Trabeculotomy Combined With Trabeculectomy In The Treatment Of Congenital Glaucoma

Objective:To evaluate the efficacy and safety of modified trabeculotomy combined with trabeculectomy in the treatment of congenital glaucoma.Methods:Retrospective analysis method research was used for the study of the congenital glaucoma patients treated in our hospital during January2010and February2013.27patients (42eyes) of congenital glaucoma were divided into2groups:adolescent congenital glaucoma group (20cases,32eyes) and infant congenital glaucoma group (7cases,10eyes). All patients received the-treatment of modified trabeculotomy combined with trabeculectomy. Visual acuity, intraocular pressure, filtering blebs, anterior chamber, the ratio of C/D, vision, retinal nerve fiber layer and complications were observed postoperatively.Results:All patients were followed up from1to29months (13.3±7.7months).(1)There were no statistically significant differences in visual acuity between preoperative period and postoperative period respectively in adolescent congenital glaucoma group (P>0.05).(2)Functional filtering bleb formation rate after operation in two groups was100%.(3)The mean IOP in adolescent congenital glaucoma group were27.9±9.8mmHg preoperatively and10.2±4.0mmHg postoperatively; while38.2±8.8mmHg preoperatively and13.6±3.1mmHg postoperatively in infant congenital glaucoma group. The changes of IOP in two groups were both statistically different (P<0.05).(4)The cup/disc ratio in adolescent congenital glaucoma group were0.85±0.13preoperatively and0.79±0.17postoperatively (P<0.05); while were0.84±0.97preoperatively and0.84±0.12postoperatively in infant congenital glaucoma group (P>0.05).(5)Retinal nerve fiber layer index includes NFI, Superior Average (μm), Inferior Average (μm) and Inter-Eye Symmetry in adolescent congenital glaucoma group were65.71±29.62、48.46±26.48、47.79±21.85、0.56±0.33preoperatively and65.42±31.75、46.21±17.59、47.38±16.69、0.38±0.37postoperatively (P>0.05).(6)MD in adolescent congenital glaucoma group were-14.998±11.685dB preoperatively and-13.330±10.973dB postoperatively, which was statistically different (P<0.05); PSD in adolescent congenital glaucoma group were7.135±4.318dB preoperatively and6.101±4.471dB postoperatively(P>0.05).(7)6eyes (14.3%) occurred hyphema in operation;37eyes (88.1%) occurred hyphema in postoperation.But after medical therapy, it was completely absorbed; severe complications such as detachment of choroid and macular edema were not observed in all patient.(8)The successful rate of the operation in two groups was100%. Conclusion:Modified trabeculotomy combined with trabecule-ctomy can effectively decrease the IOP of congenital glaucoma, and protect the visual function of patients. The operation is a safe and effective method for the treatment of congenital glaucoma.