Reem M. Aboulhassan MSc, Yasmine M. ElSayed MD, Amanne Esmael MD, Ghada Gawdat MD, Ahmed ElKateb MD, Hala ElHilali MD
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Abstract
Purpose
The aim of this study was to compare the outcomes of 2-site rigid probe trabeculotomy (RPT) compared to gonioscopy-assisted transluminal trabeculotomy (GATT) in the treatment of primary congenital glaucoma (PCG).
Design
A prospective randomized controlled study
Subjects
The study included 77 eyes of 60 patients with PCG with clear corneas all aged < 5 years.
Methods
Patients were randomized to undergo either 2-site trabeculotomy using a RPT or GATT using a 5/0 polypropylene suture. Success was defined as achieving a final intraocular pressure (IOP) < 18 mmHg without (complete) or with medications (qualified).
Main Outcome Measures
Primary outcomes were reduction of IOP and medications. Secondary outcomes were complications and success rates. Anterior segment OCT (AS-OCT) was performed to compare changes in angle morphology.
Results
The two-site RPT group included 39 eyes, and the GATT group included 38 eyes. There was a significant reduction in IOP and glaucoma medications at 1, 3, 6, 9, and 12 months postoperatively in both groups (P < 0.001) with no significant difference in IOP or IOP-lowering medications between both groups at any follow-up (FU). At the final FU, there was a 49% ± 13% IOP reduction in the 2-site RPT trabeculotomy group compared to 44% ± 25% in the GATT group (P = 0.2). Success was achieved in all eyes in the RPT group and in 95% in the GATT group. Hyphema was the most frequently observed complication; with no vision-threatening complications in either group. Postoperative AS-OCT findings included angle widening, trabecular shelf, and peripheral anterior synechia.
Conclusions
Circumferential trabeculotomy using ab interno GATT or ab externo 2-site trabeculotomy yielded comparable results in terms of safety and efficacy. Gonioscopy-assisted transluminal trabeculotomy has the advantage of sparing the conjunctiva which may be needed for future interventions.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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