الفهرس 
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Abstract
This study was designed to compare three surgical techniques used in the treatment of primary congenital glaucoma. The study was conducted on 33 eyes of 22 patients – 10 of which had consanguineous parents- with the diagnosis of primary congenital glaucoma. All patients were subjected to a thorough history taking including the age at onset, age at presentation, mode of presentation, parental consanguinity, antenatal history, mode of delivery and early postnatal history, family history and any concurrent systemic disease. Study eyes were then divided into three groups 1,2 and 3. The mean (±standard deviation) age of presentation was 7.43(±5.17) months. In groups 1, 2 and 3 the mean (±SD) age was 4.63(±3.47), 6.08(±3.70) and 11.60(±8.35) months respectively. The disease was unilateral in 9 patients; 7 right eyes and 2 left eyes, and bilateral in 13 patients.
The patients were then subjected to a routine preoperative examination under general anaesthesia in which assessment of intraocular pressure (IOP), corneal diameter and clarity, axial length (AL), fundus and optic disc appearance and cycloplegic refraction -when possible- was done. The most common presentation was a corneal haze occurring in 20 eyes; an enlarged eye next in frequency occurring in 14 eyes; watering next in frequency occurring in 13 eyes; with one patient (2 eyes) discovered accidentally. The mean (±SD) preoperative IOP was 20.07 (±6.70) mmHg. In groups 1, 2 and 3 the mean (±SD) IOP was 20.90 (±6.02), 20.41 (±6.25) and 18.90 (±7.83) mmHg respectively.
Study eyes were divided into three groups, group1 included 11 eyes and were subjected to a trabeculotomy operation, group 2 included 12 eyes and were subjected to a combined trabeculotomy and trabeculectomy operation and group 3 included 10 eyes and were subjected to a combined trabeculotomy and trabeculectomy with mitomycin C operation. Intraoperative complications included hyphema; occurring in all study eyes, perforation into anterior chamber; occurring in 5 eyes and vitreous loss occurring in 1 eye.
Postoperative examination under general anaesthesia was conducted at monthly intervals for all patients for six months. Control of the intraocular pressure was achieved in 9 eyes in group 1, 11 eyes in group 2 and all 10 eyes of group 3 and these eyes were classified as successful outcome. In these eyes, control of IOP was achieved as early as the first postoperative month. At the end of six months follow up period the mean (±SD) postoperative IOP was 7.68(±4.56) mmHg. In groups 1, 2 and 3 the mean (±SD) IOP was 8.91(4.59), 10.25(6.96) and 3.90(2.13) respectively.
The mean postoperative IOP was maintained at an almost steady level of control throughout the follow up period. The mean postoperative IOP in group 3 was the lowest of all 3 groups. Both groups 1 and 2 had a comparable mean IOP level, higher than in group 3, with group 2 demonstrating a slightly higher level of IOP than group 1. Follow up of the axial length in all three study groups revealed a steady increase in axial length during the follow up period, which was attributed to the normal growth pattern of the study eyes which were in the period of active eye growth; the first 2 years of life. The same trend of progressive increase was found in the corneal diameters of all study eyes. Studying the cup/disc ratio revealed all three outcomes: stabilization of cupping in the majority of eyes, reversal of cupping in a few eyes and progressive cupping in two eyes. The overall success rate was 90.9%. In groups 1, 2 and 3 the success rates were 81.82%, 91.67% and 100% respectively.