Comparing combined trabeculotomy-trabeculectomy with gonioscopy-assisted transluminal trabeculotomy as primary surgery for primary congenital glaucoma.

PURPOSE: The purpose of this study was to compare surgical outcomes and safety profiles of gonioscopy-assisted transluminal trabeculotomy (GATT) versus combined trabeculectomy and trabeculotomy (CTT) in primary congenital glaucoma (PCG) at 12 months.

DESIGN

Retrospective comparative analysis.

METHODS

Children with mild-to-moderate PCG who underwent either GATT or CTT between December 2021 and June 2023 were included. Patients' data recorded at baseline and at postoperative periods of 1st, 3rd, 6th, and 12th months were analyzed. Intraocular pressure (IOP) reduction, incidence of complications, and the need for repeat examinations under anesthesia (EUA) were analyzed. Surgical success was defined as absolute when IOP ≤18 (criterion A) and ≤15 mmHg (criterion B) was achieved without medications and qualified, when achieved with medications. Failure was defined as IOP >18 mmHg on maximal medical therapy, IOP <6 mmHg, or the need for additional IOP-lowering surgery. Multivariate regression analysis was used to assess baseline predictors for binary outcomes (surgical success and any complication).

RESULTS

Ninety-eight eyes from 68 children diagnosed with PCG were analyzed, having undergone either CTT (58 eyes) or GATT (40 eyes) with 12-month follow-up, which showed similar success rates (P = 0.6, Log Rank test). Multivariate analysis did not identify any significant baseline predictors of surgical success. Postoperative complications (34% vs 20%; adjusted P = 0.02) and need for repeat EUAs (0 vs 1.27/eye; P = 0.05) were significantly higher in the CTT group.

CONCLUSIONS

In mild-moderate PCG eyes, GATT demonstrated similar surgical success with a better safety profile than CTT and can be preferred as the first-line surgical modality.