Surgical Outcomes of Trabeculotomy in Newborns with Primary Congenital Glaucoma

Abstract

Background:Early surgical intervention is required for the primary congenital glaucoma (PCG). There are currently few reports on the surgical outcomes in infants with PCG. This study aimed to evaluate the efficacy and safety of trabeculotomy and the postoperative visual outcomes in Chinese newborns with PCG within 4 weeks of birth.Methods:A total of 21 eyes of 12 patients with PCG who underwent primary trabeculotomy within 4 weeks of birth were retrospectively studied. Preoperative and postoperative intraocular pressure (IOP), corneal clarity and diameter, axial length and optic disc cupping, visual acuity and postoperative refractive error, success rates, and complications were evaluated. Kaplan-Meier survival analysis was applied to evaluate the success rates.Results:The mean follow-up time was 46.9 ± 34.4 months (range: 12–122 months). The postoperative IOP was significantly lower than the preoperative IOP at all of the follow-up visits (P < 0.001). The complete success rates for all eyes at 1, 2, 3, and 5 years postoperatively were 90.5%, 85.7%, 85.7%, and 85.7%, respectively. The IOPs of the three patients who needed antiglaucomatous medications postoperatively were also well controlled. At the last visit, the cornea became clear, and the cup-to-disc ratio decreased significantly (P = 0.01) although the horizontal corneal diameter did not change significantly (P = 0.11). Visual acuities were able to be recorded in eight eyes at the last visit, among which six eyes had a best-corrected visual acuity of 20/40 or better. There were no severe intraoperative or postoperative complications.Conclusions:Trabeculotomy proves to be a safe and effective treatment in reducing IOP in this group of Chinese newborns with PCG. The outcomes of vision function were satisfactory in most of the patients.

Long-Term Visual Outcomes in Children with Primary Congenital Glaucoma

“…Visual acuity prognosis was not addressed in several studies that evaluated the surgical outcomes of congenital glaucoma (6). However, several other studies on postoperative PCG outcomes reported variable VA outcome (5,9,(14)(15)(16). A normal to near-normal VA (20/20 to 20/50) was achieved in 41%-79% of eyes, as summarized in Table VI (5,9,14,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26).…”

Trabeculotomy versus combined trabeculotomy–trabeculectomy for primary congenital glaucoma: study protocol of a randomised controlled trial

“…This technique has been previously described 8. In brief, a superior quadrant fornix-based flap will be created.…”

“…Trabeculotomy reduces intraocular pressure (IOP) by tearing the trabecular meshwork into the anterior chamber. Regarding complications, hyphema is more common in trabeculotomy but can resolve spontaneously and cause no additional problems 7–9…”

Ab Interno Goniotomy Combined with Ab Externo Trabeculotomy in Advanced Primary Congenital Glaucoma Patients: 2-Year Follow-Up

“… 12 , 13 A clear cornea that permits good visualization of the angle structures is an essential parameter for goniotomy. 14 , 15 A cloudy and opacified cornea due to markedly elevated IOP is typically found in buphthalmos cases. Trabeculotomy is believed to be the ideal surgery in this situation, 15–17 while goniotomy can be performed with some effort; typically, the surgeon has to choose between goniotomy and trabeculotomy.…”

“…14 , 15 A cloudy and opacified cornea due to markedly elevated IOP is typically found in buphthalmos cases. Trabeculotomy is believed to be the ideal surgery in this situation, 15–17 while goniotomy can be performed with some effort; typically, the surgeon has to choose between goniotomy and trabeculotomy. 18 The selection of surgery may depend on the corneal diameter, as successful incisional angle surgery may be restricted to corneal diameters less than 14 mm.…”