Outcomes of needle-assisted circumferential goniotomy (NAG) in primary congenital glaucoma (PCG).

Abstract

Purpose: To evaluate the safety and efficacy of needle-assisted circumferential goniotomy (NAG) in primary congenital glaucoma (PCG).

Methods: This is a hospital-based prospective interventional study. Patients diagnosed with PCG, aged <2 years with good corneal clarity, who underwent NAG procedure in a single tertiary eye care center, were included in the study and were followed up regularly in the post-operative period. The pre- and post-operative intraocular pressure (IOP), number of anti-glaucoma medications (AGMs), corneal diameter, axial length, fundus findings, and any complications were recorded at 3, 6, 9, and 12 months. Success was defined as IOP ≤ 18 mmHg with or without two topical AGMs.

Results: A total of 52 eyes (14 bilateral and 24 unilateral) of 31 children were included in the study. A total of 80.6% were males and 19.4% were females, with a mean age of 1.14 ± 1.04 years. The baseline IOP was 23.28 ± 5.98 mmHg, which decreased to 11.03 ± 5.06 mmHg at 3 months, 12.08 ± 3.80 mmHg at 6 months, and 12.54 ± 5.09 mmHg at 12 months, P value < 0.001. The mean number of topical AGMs reduced from 2.48 ± 1.03 to 1.35 ± 1.23 at 12 months follow-up, P value < 0.001. Complete success was seen in 88.46% (46/51) eyes. Failure was noted in 11.52% (10/51) eyes, out of which 9.61% (9/51) eyes required trabeculectomy. There were no significant vision-threatening intraoperative or post-operative complications.

Conclusion: A 24G NAG is a safe and effective surgical procedure to control the IOP in PCG with good corneal clarity. NAG is a single-sitting, minimally invasive, circumferential angle surgery that spares the conjunctiva completely for future surgeries, if needed.