Illuminated microcatheter-assisted trabeculotomy effective for congenital glaucoma

This retrospective study shows that illuminated microcatheter-assisted trabeculotomy can treat childhood glaucoma with a better success rate and greater IOP control compared to traditional trabeculotomy.

This is the largest study to date comparing microcatheter-assisted and traditional rigid probe trabeculotomy in 36 patients (43 eyes) with both primary and secondary childhood glaucoma. Accurate placement of the trabeculotome into Schlemm’s canal can be difficult, and may result in inadvertant tissue damage. An illuminated microcatheter improves visualization by allowing verification of the catheter tip location which prevents misdirection.

At 1 year postop, patients who underwent 360° microcatheter-assisted trabeculotomy had significantly lower IOP (19.0 mmHg vs. 14.8 mmHg, P=0.049), greater reduction in IOP (47.3% vs. 34.2%, P=0.036) and had a 30% higher success rate, defined as at least 30% IOP reduction without topical medication (P=0.06).

There were no serious complications in the microcatheter-assisted group and 1 case of choroidal detachment in the traditional trabeculotomy group, which investigators speculate was a result of a false passage into the suprachoroidal space.

These findings are consistent with results from a small study in 2015 that found a higher success rate with 360° trabeculotomy for primary congenital glaucoma. Additionally, both this and the 2015 study reported that this technique offered no long-term success over traditional trabeculotomy for eyes with Sturge–Weber syndrome, aniridia or isolated sclerocornea.

The authors suggest that larger samples sizes are needed to identify the indications for this new procedure.