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 2 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 through low-cost Prolene sutures with the facilitation of the Schlemm's canal (SC) cannulation using viscoelastic.

METHODS

This retrospective interventional study compared the 1-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 2 years, both surgical techniques demonstrated significant IOP reduction from baseline (GATT: mean reduction of 15.33±2.56 mmHg; AVCST: mean reduction of 15.96±2.95 mmHg) but there was no statistical difference between both groups at 2 years ( P =0.371). The complete success rate, defined as an IOP ≤16 mmHg 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 2 groups ( P =0.710). The complication rates were comparable between the 2 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 2 years. Further long-term studies are warranted to assess the durability of these outcomes.