Combined trabeculotomy-trabeculectomy using the modified Safer Surgery System augmented with MMC: its long-term outcomes of glaucoma treatment in Asian children

  • Cherng-Ru Hsu
  • Yi-Hao Chen
  • Ming-Cheng Tai
  • Da-Wen Lu



This study aimed to study the long-term surgical outcomes of combined trabeculotomy–trabeculectomy (CTT) using the modified Safer Surgery System in treating childhood glaucoma at a tertiary medical center in Taiwan.


Retrospective, consecutive, noncomparative case series. We retrospectively reviewed medical records of 42 pediatric patients (age 0–18 years) who had CTT performed on their 65 eyes using the modified Safer Surgery System. The study period spanned 18 years (from January 1, 1997, to December 31, 2014). We evaluated the outcome in terms of postoperative intraocular pressure (IOP), axial length growth, disc cupping reversal, and use of antiglaucoma medications. The surgical success was rated using the Kaplan–Meier survival analysis and based on the incidence of complications.


The mean follow-up period was 85.05 ± 32.17 months (range 14–200). After operation, IOP dropped significantly from 35.76 ± 9.44 mmHg (mean ± SD) to 16.18 ± 7.20 mmHg together with a significant reversal of optic disc cupping. Similarly, the use of antiglaucoma medications was also significantly reduced in number from 1.26 ± 0.50 to 0.43 ± 0.70. Most of the axial lengths of the eyes measured at the last follow-up visit showed growths within the average ± 2 SDs in comparison with the healthy, age-matched population. After surgery, the qualified success rate was 90.77% at the end of the first year, 90.77% at the second year, 87.64% at the fifth year, 84.51% at the 10th year, and 81.38% at the 15th year. No serious intraoperative or postoperative complications were found.


For Taiwanese children, the combined trabeculotomy–trabeculectomy using the modified Safer Surgery System offered an efficient and safe surgical option for treating glaucoma with long-term satisfactory control of IOP.


Combined trabeculotomy–trabeculectomy Childhood glaucoma Modified safer surgery system 


Funding information

This research received research grant from the Tri-Service General Hospital, Taipei, Taiwan (TSGH-C106-082), and the National Defense Medical Center, Taipei, Taiwan (MAB101-12 and MAB-102-94).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Cherng-Ru Hsu
    • 1
  • Yi-Hao Chen
    • 1
  • Ming-Cheng Tai
    • 1
  • Da-Wen Lu
    • 1
  1. 1.Department of OphthalmologyTri-Service General Hospital, National Defense Medical CenterTaipei CityRepublic of China

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