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Abstract #127576 Published in IGR 25-3
Two-Year Results of Gonioscopy-Assisted Transluminal Trabeculotomy Versus Ab Externo Visco Circumferential Suture Trabeculotomy in Primary Congenital Glaucoma
Elwehidy AS; Elhofi AS; Abdelkader AME; GabAllah NMJournal of Glaucoma 2025; 34: 811-818
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.
Department of Ophthalmology, Mansoura University, Mansoura.
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