Microcatheter-Assisted Circumferential Trabeculotomy in Primary Congenital Glaucoma: Long-Term Clinical Outcomes.

Luigi Fontana,Alberto Neri

doi:10.3390/jcm11020414

Abstract

Purpose: The purpose of this study was to report the long-term efficacy and clinical outcomes of microcatheter-assisted circumferential trabeculotomy (MCT) in children with primary congenital glaucoma (PCG). Methods: This is a single-center retrospective study including consecutive children with PCG who underwent MCT with > two years follow up. The primary outcome was surgical success, defined as intraocular pressure (IOP) ≤ 21 mmHg with (qualified) or without (complete) medications, measured at six months, one year, and then annually. Secondary outcomes were visual acuity (VA), refraction, axial length (AXL), complications, reinterventions, and number of medications. Results: Twelve eyes of ten patients were included. In eight children only one eye was affected. The mean ± standard deviation (SD) age at surgery was 6.3 ± 4.1 months. The mean postoperative follow-up was 66 ± 35 months. The mean IOP was 34.3 ± 9.6 mmHg preoperatively and 14.6 ± 2.3 mmHg postoperatively at the last visit (p < 0.001). Complete success was achieved at all time points in 10 out of 12 eyes, while 2 eyes had a qualified success. At three years of age, the mean VA of the operated eyes was 0.25 ± 0.12 logMAR, the mean spherical equivalent was −0.78 ± 1.43 diopters, and the mean AXL was 23.78 mm. Transient hyphema was the only complication observed. None of the children required additional glaucoma surgery. Conclusions: Circumferential trabeculotomy for PCG effectively lowers the IOP at more than two years after surgery. Following this procedure, the prognosis for the visual function is good, and the refractive error is low. Postoperative complications were not significant.

Highlights

Primary congenital glaucoma (PCG) is the most common non-syndromic glaucoma in childhood, occurring in one of 10,000–20,000 live births in western countries [1,2]
Angle surgery is the mainstay of treatment of PCG [4,5,6], with the choice between goniotomy and trabeculotomy dictated by corneal clarity, surgeon’s experience, and preference [3,7]
In this single-center retrospective study, we analyzed the clinical outcomes of patients with PCG treated by microcatheter-assisted circumferential trabeculotomy (MCT) at the Ophthalmology Unit of Azienda USL–IRCCS di Reggio

Summary

Introduction

Primary congenital glaucoma (PCG) is the most common non-syndromic glaucoma in childhood, occurring in one of 10,000–20,000 live births in western countries [1,2]. In. PCG, the whole eye is modified and damaged by high intraocular pressure (IOP) due to isolated trabeculodysgenesis [3]. Angle surgery is the mainstay of treatment of PCG [4,5,6], with the choice between goniotomy and trabeculotomy dictated by corneal clarity, surgeon’s experience, and preference [3,7]. The results of angle surgery are good, with most studies citing a 70% to 90% rate of success for both goniotomy and trabeculotomy [8]. Approximately 1/3 of the iridocorneal angle is opened with both techniques, often requiring repeated procedures to obtain effective IOP control, using a step-wise approach [8]. A metallic trabeculotome probe can create a false passage, causing tissue disruption [9]

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