Long-term Results of Combined Trabeculotomy-Trabeculectomy in Primary Congenital Glaucoma from a Tertiary Eye Care Center in Tunisia

Objective To report the long-term visual and surgical outcomes of combined trabeculotomy–trabeculectomy (CTT) as the initial glaucoma surgery in children with primary congenital glaucoma (PCG). Methods Prospective analysis of children who underwent primary CTT for PCG between January 2010 and December 2019. The main outcome measures were intraocular pressure (IOP) reduction, corneal clarity, success rate, complications, refractive errors and visual acuities (VA). Results A total of 98 eyes of 62 patients were enrolled. At last follow-up, mean IOP reduced from 22.68±3.99 mmHg to 9.75±3.88 mmHg (P<0.0001). Complete success rate was 91.6%, 88.4%, 84.7%, 71.6%, 59.7%, and 54.3%, respectively at first, second, fourth, sixth, eighth, and tenth year. Follow-up averaged 42.06±28.36 months. Preoperatively, 72 eyes (73.5%) had significant corneal haze, 84.7% among them achieved normal corneal transparency. Among the sight-threatening complications, endophthalmitis was encountered in one eye. Myopia was the most common refractive error (80.6%). Data on Snellen VA were available for 53.2% of the patients. 33.3% of patients achieved normal VA (VA ≥ 6/12), 21.2% had mild visual impairment (VI), 9.1% had moderate VI, 21.2% had severe VI, and 15.2% were blind. The failure rate was statistically correlated to the early disease onset (<3 months) and to preoperative corneal clouding (p=0.022 and p=0.037, respectively). Two critical time points were identified: within the first year and around the sixth year (28.6 and 25% of surgical failures, respectively). Conclusion Primary CTT seems to be an optimal procedure in a population with advanced disease at presentation, problematic follow-ups, and limited resources. What is already known on this topic What this study adds? How this study might affect research, practice or policy ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work has not been funded by any public or private institution. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of Aziza Othmana Hospital, Tunis, Tunisia approved this research. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors