Nazli Gul, Muhammad Naeem Khan, Hina Khan, Tahir Ali, Afzal Qadir.
Surgical Outcome of Primary Trabeculectomy Augmented with Mitomycin C in Primary Congenital Glaucoma.
Ophthalmol Update Jan ;16(2):617-20.

Objective: To evaluate the surgical outcome of primary trabeculectomy with mitomycin C (MMC) in primary congenital glaucoma (PCG). Method: This descriptive case series was conducted at Khyber Institute of Ophthalmic Medical Sciences (KIOMS), Hayatabad Medical Complex (HMC), Peshawar from February, 2015 to November, 2016. 53 consecutive pediatric patients with PCG were included in the study. Primary trabeculectomy with MMC was performed in all patients under general anesthesia. Pre-operative and post operative intraocular pressure (IOP) using Perkin tonometer, corneal clarity, corneal diameter ,cup to disc ratio (CD ratio) and retinoscopy where possible were performed under general anesthesia. Results: This study included 53 eyes of 53 patients. In case of bilateral disease only one eye with advanced glaucoma was included in our study. Thirty four patients (64.2 %%) were male and 19 (35.8%) were female. Mean age at presentation was 12.36 months (SD±6.31). Mean pre operative IOP was 42.17 mmHg (SD±8.40). Pre operative mean corneal diameter was 13.45mm (SD±0.70). Significant corneal edema / scarring obscuring iris details were present in 22 eyes (41.5%). All eyes underwent primary trabeculectomy with MMC. Examination under general inhalational anesthesia was performed in all patients at 1 week, 6 weeks and 3 months postoperatively. Final surgical outcome was assessed at 3 months post operatively. The criteria for surgical success were average IOP of 21 mmHg with or without topical antiglaucoma medications. SPSS version 16 was used for data analysis. Post operative mean corneal diameter was 13.58mm (SD±0.85). Mean post operative IOP was 18.87 mmHg (SD±.6.63) which is statistically significant. Successful cases had an IOP of 21mmHg or less was achieved in 40 eyes (75.5%) with resolution of corneal edema and no progression of corneal diameters or CD ratio at final follow up. Thirteen eyes (24.5%) have failed surgeries with uncontrolled IOP, enlargement of corneal diameters/ progression of CDR. There was no major intra operative complications, blebitis or endophthalmitis. Conclusion: Primary trabeculectomy with MMC is an effective procedure with good surgical outcome for the management of PCG.

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