Risk Factors for Trabeculotomy Failure in Primary Congenital Glaucoma

Abstract

Précis: This study demonstrates that a baseline corneal diameter >12.25, initial age <4 months at diagnosis, higher baseline IOP than 24 mm Hg, bilaterality, or inability to perform circumferential trabeculotomy, increases the risk of surgical failure of trabeculotomy in patients with primary congenital glaucoma (PCG). Purpose: The aim of this study was to identify clinical predictive factors for surgical failure and to evaluate potential prognostic factors affecting surgical success in patients with PCG who underwent trabeculotomy. Patients and Methods: The medical charts of 123 eyes of 75 patients who underwent trabeculotomy surgery for the treatment of PCG were retrospectively reviewed. At baseline and each visit, intraocular pressure (IOP), corneal diameter, cup to disc ratio, axial length, number of medications, and need for further glaucoma surgery were noted. Surgical success was defined as an IOP ≤18 mm Hg and 20% IOP reduction from baseline with (qualified) or without (complete) medication and without any further IOP-lowering surgery. Results: The mean age at surgery was 4.2±6.6 months and the mean follow-up time was 60.0±37.6 months. The receiver operating characteristic curve showed 4 following best cutoff values to predict surgical failure: the first for age at surgery was 4.5 months; the second baseline IOP was 24.0 mm Hg; the third for baseline cup to disc ratio was 0.4; and the fourth for baseline corneal diameter was 12.25 mm. Multivariate logistic regression analysis revealed that baseline IOP more than 24 mm Hg increased the risk of surgical failure by 2 times, baseline mean corneal diameter >12.25 mm did by 4.2 times, younger age than 4 months did by 2.5 times, bilaterality did by 1.5 times. Conclusions: A higher baseline IOP, younger age, larger corneal diameter, and bilaterality were identified as risk factors for trabeculotomy failure in congenital glaucoma. The presence of one or more of these should be considered in the decision-making process when considering surgical options to manage glaucoma in these patients.

Surgical Outcomes of Early Versus Late Onset Glaucoma Associated With Sturge-Weber Syndrome

“…A possible cause for the surgical failure to occur earlier in children with early-onset disease could be due to the fact that we have performed conventional trabeculotomy (probe) and not circumferential trabeculotomy (suture or catheter). The inability to perform circumferential suture trabeculotomy increases the risk of surgical failure in primary congenital glaucoma 24 . An increasing number of studies have demonstrated that ab externo Microcatheter-assisted trabeculotomy (MAT) or a 360-degree circumferential trabeculotomy is a more effective treatment than traditional rigid probe trabeculotomy for childhood glaucoma 25–27 .…”

“…The inability to perform circumferential suture trabeculotomy increases the risk of surgical failure in primary congenital glaucoma. 24 An increasing number of studies have demonstrated that ab externo Microcatheterassisted trabeculotomy (MAT) or a 360-degree circumferential trabeculotomy is a more effective treatment than traditional rigid probe trabeculotomy for childhood glaucoma. [25][26][27] Hu et al 28 recently showed that ab externo MAT had remarkably good outcomes as the primary therapy in their series of 13 eyes with early-onset glaucoma associated with SWS.…”