Comparison of 360-Degree Trabeculotomy Versus Traditional Angle Surgery in Primary Congenital Glaucoma: A Systematic Review and Meta-Analysis.

PRCIS: Systematic Meta-Analysis demonstrates greater IOP reduction, fewer glaucoma medication uses, and a higher surgical success rate with 360-degree trabeculotomy compared with traditional angle surgery in primary congenital glaucoma.

PURPOSE: Primary congenital glaucoma (PCG) is a rare vision-threatening disorder that can lead to blindness if untreated. The aim of the study is to compare the effectiveness of traditional angle surgery (goniotomy and rigid-probe trabeculotomy) versus 360-degree trabeculotomy in children with PCG.

METHODS

A comprehensive search was conducted across PubMed, EMBASE, Scopus, Cochrane (CENTRAL), ScienceDirect, and Clinicaltrials.gov. A total of 1740 studies were obtained from databases, and 12 studies, 3 RCTs, and 9 Retrospective studies met the inclusion criteria. Mean Differences (MD) for continuous outcomes and Odds Ratios (OR) for dichotomous outcomes were analyzed. The primary outcomes were the reduction in intraocular pressure (IOP) and the number of antiglaucoma medications at 12 months postoperatively.

RESULTS

Pooled analysis of 778 eyes demonstrated that 360-degree trabeculotomy showed a significant reduction in IOP and number of antiglaucoma medications compared with traditional angle surgery by -2.10 mm Hg (-3.26 to -0.94; P =0.0004, I2 =55%) and -0.47 drops (-0.69 to -0.25; P <0.0001, I2 =55%), respectively. Compared with traditional angle surgery group, the 360-degree trabeculotomy group showed higher complete and qualified success rates with OR of 5.07 (3.43-7.50; P <0.0001, I2 =4%) and 3.00 (1.47-6.12; P =0.003, I2 =46%) respectively, and as well as, reduction in failure rate with OR of 0.18 (0.11-0.31; P <0.0001, I2 =14%). No statistically significant differences were observed for postoperative axial length, change in cup/disc ratio, or change in horizontal corneal diameter.

CONCLUSIONS

360-degree trabeculotomy showed greater reduction in IOP and number of antiglaucoma medications postoperatively than traditional angle surgery with improved success and reduced failure rates.