DEC 18, 2012
Pediatric Ophth/Strabismus
Circumferential trabeculotomy performed with an illuminated microcatheter appears to be more effective than ab interno goniotomy for the treatment of congenital glaucoma, according to retrospective data from the first year after surgery.
The authors reviewed the charts of 20 patients (24 eyes) with congenital glaucoma who underwent catheter-assisted trabeculotomy with an illuminated microcatheter or goniotomy. Success with either approach was defined as IOP < 21 mmHg with at least a 30 percent reduction from preoperative levels at the 12-month follow-up. "Complete success" was reaching target IOP without antiglaucoma medication, and "qualified success" was reaching target IOP with medication.
Microcatheter-assisted circumferential trabeculotomy demonstrated a 91.6 percent qualified success rate and 83.3 percent unqualified success rate, compared to 53.8 percent and 46.2 percent, respectively, for conventional goniotomy. There were no complications in either group.
The authors note that a possible significant bias between the groups was that more eyes in the trabeculotomy group had prior angle surgery. This group also had two patients with secondary glaucoma from Sturge-Weber syndrome. Another limitation was that the groups were not contemporaneously compared because the authors stopped performing goniotomy as their primary surgical treatment for congenital glaucoma once they began using circumferential trabeculotomy.