Five-year results of viscotrabeculotomy versus conventional trabeculotomy in primary congenital glaucoma: A randomized controlled study

Abstract

Purpose To assess the long-term results of viscotrabeculotomy in infants with primary congenital glaucoma and to compare its outcome with conventional trabeculotomy. Patients and methods A prospective randomized comparative study included infants with primary congenital glaucoma younger than 2 years. Patients were divided into two groups: viscotrabeculotomy group and conventional trabeculotomy group. Preoperative and postoperative intraocular pressures, corneal diameter, intraoperative and postoperative complications, and success rates were compared between two groups. All the patients were followed up for 5 years. Results The study included 154 eyes of 92 infants distributed randomly among the two groups; 78 and 76 eyes in viscotrabeculotomy and conventional trabeculotomy groups, respectively. In both groups, there was a statistically significant intraocular pressure reduction at all time points of the follow-up periods compared to the preoperative values (p < 0.0001). At 5 years, viscotrabeculotomy group showed significant reduction of the mean postoperative intraocular pressure (49.47%) than conventional trabeculotomy group (48.64%) (p < 0.0001). Intraocular pressure was statistically lower in viscotrabeculotomy starting from 12th month and till the end of the follow-up. At 5 years, the total success rate of viscotrabeculotomy group was 89.74% compared to 85.53% in conventional trabeculotomy group without significant difference (p = 0.487). The postoperative mean values of the cup/disk ratio in viscotrabeculotomy group showed statistically lower values compared to conventional trabeculotomy group (p = 0.019). Postoperative hyphema was statistically higher in conventional trabeculotomy group (p < 0.0001). All eyes that underwent a reoperation before 5 years follow-up were excluded from the statistical workup of the study after reoperation, except for calculation of success/failure. Conclusion Viscotrabeculotomy and conventional trabeculotomy proved to be effective in cases of primary congenital glaucoma. Viscotrabeculotomy appeared to have prolonged stability in controlling the intraocular pressure with higher success rates and lower complications.

Surgical Outcomes of Visco-Circumferential-Suture-Trabeculotomy Versus Rigid Probe Trabeculotomy in Primary Congenital Glaucoma: A 3-Year Randomized Controlled Study

“…18 The IOP outcome in the VT group reported in this study is comparable to that reported for VT by the authors in other studies. 5 The success rates reported in this study emphasize the fact that angle surgery is highly successful in controlling IOP in PCG. An advantage for VCST over VT is exemplified by the higher success rates, and more so; the higher percentage of complete success (with less dependence on IOP-lowering medications in the VCST group than in the VT group), though not statistically significant.…”

“…and followed a standard protocol which was previously described by the authors. 5 Perkin's handheld applanation tonometer (Haag Streit USA and Reliance Medical Products, Mason, OH) was used for IOP measurement with the eyes central just after the induction of GA. Because of the known effect of inhalational GA of IOP reduction, if PCG was suspected with a low measured IOP, serial follow-ups were scheduled to monitor progression of corneal diameter, axial length, and optic disc cupping to establish the diagnosis of PCG. The children were then scheduled for surgery and the eyes randomly assigned (using simple randomization by flipping a coin) for the procedure of "Visco-Circumferential Suture Trabeculotomy" (VCST) or "Viscotrabeculotomy" (VT).…”

“…VT was proved to be more effective than conventional probe trabeculotomy for reduction of IOP in PCG with more stability, higher success rates, and lower complications. 5 In order to combine the advantages of the use of ophthalmic viscosurgical devices and those of circumferential trabeculotomy without the need for an illuminated microcatheter, the authors suggest this technique (Visco-Circumferential-Suture-Trabeculotomy "VCST"). The authors hypothesize that the injection of a viscoelastic into both ends of the unroofed SC before its cannulation by a polypropylene suture and subsequent circumferential trabeculotomy may facilitate circumferential cannulation of SC and hence the trabeculotomy and increase the success of the technique.…”

Visco-Circumferential-Suture-Trabeculotomy Versus Rigid-Probe Viscotrabeculotomy in Neonatal-Onset Primary Congenital Glaucoma

“…For rigid-probe SEVT, the surgical technique was previously described in details. 9 Postoperative treatment included topical ofloxacin and dexamethasone 5 times daily with gradual tapering over 1 month. Timolol and/or dorzolamide drops were administered twice daily when needed.…”

“…VT was shown to be at least as effective and as safe as conventional probe trabeculotomy for the reduction of IOP in PCG. 8,9 Circumferential trabeculotomy (CT) provides complete rupture of the TM and Schlemm canal (SC) inner wall, with better improvement in IOP reduction than rigid-probe single-entry trabeculotomy. 7 Different techniques of CT are now available in PCG management with improved success including illuminated microcatheter-assisted CT, 360degree suture trabeculotomy, visco-circumferential-suturetrabeculotomy (VCST), and rigid-probe double-entry trabeculotomy.…”