Two-year Results of Gonioscopy-Assisted Transluminal Trabeculotomy versus Ab-Externo Visco Circumferential Suture Trabeculotomy in Primary Congenital Glaucoma.

Precis: Both Gonioscopy-assisted transluminal trabeculotomy and Ab-Externo Visco Circumferential Suture Trabeculotomy reduced the intraocular pressure in primary congenital glaucoma by more than 50% from baseline at two years. There were no serious adverse events.

Purpose: Primary congenital glaucoma (PCG) is a severe form of glaucoma that presents in infancy and requires surgical intervention to prevent irreversible vision loss. Angle-based surgery is the primary treatment for PCG, with recent reports suggesting promising outcomes for gonioscopy-assisted transluminal trabeculotomy (GATT) in children with PCG. Ab-Externo Visco Circumferential Suture Trabeculotomy (AVCST) offers the advantages of combining the efficacy of 360-degree circumferential trabeculotomy via low-cost Prolene sutures with the facilitation of the Schlemm's canal (SC) cannulation using viscoelastic.

Methods: This retrospective interventional study compared the one-year outcomes of GATT and AVCST in managing PCG. The records of 65 eyes of 39 children who underwent surgery for their PCG were reviewed.

Results: The key outcome measures included reduction of intraocular pressure (IOP), the success rate, and surgical complications. At two years, both surgical techniques demonstrated significant IOP reduction from baseline (GATT: mean reduction of 15.33±2.56 mm Hg; AVCST: mean reduction of 15.96±2.95 mm Hg) but there was no statistical difference between both groups at 2 years (P=0.371). The complete success rate, defined as an IOP ≤16 mm Hg with > 30% reduction from the baseline without antiglaucoma medications (AGMs) or further surgical interventions, was 87.1% for the GATT and 85.3% for the AVCST, which was not statistically significant between the two groups (P=0.710). The complication rates were comparable between the two groups, with transient hyphaema being the most common adverse event.

Conclusions: Our findings indicate that GATT and AVCST are both effective and safe surgical options for PCG, with similar efficacy and complication profiles after two years. Further long-term studies are warranted to assess the durability of these outcomes.