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Abstract #15644 Published in IGR 2-3
Long-term surgical and visual outcomes in primary congenital glaucoma: 360 degrees trabeculotomy versus goniotomy
Mendicino ME; Lynch MG; Drack A; Beck AD; Harbin T; Pollard Z; Vela MA; Lynn MJJournal of AAPOS 2000; 4: 205-210
PURPOSE: To compare the visual outcome and refractive status of children with primary congenital glaucoma who underwent 360° trabeculotomy or goniotomy as an initial surgical procedure. METHODS: This retrospective study describes 24 eyes (15 patients) with primary congenital glaucoma that underwent 360° trabeculotomy as the initial procedure and 40 eyes (23 patients) that underwent goniotomy as the initial procedure. Inclusion criteria were: (1) diagnosis of primary congenital glaucoma and initial angle surgery before one year of age, (2) no other ocular or systemic diseases, (3) 360° trabeculotomy or goniotomy as the first surgical procedure, and (4) ability to obtain an Allen or Snellen visual acuity. A postoperative vision of 20/50 or better was considered good. Surgical success was defined as an intraocular pressure (IOP) less than 22 mmHg with or without medication and without evidence of a progressive optic neuropathy. RESULTS: The IOP was successfully controlled in 92% of eyes in the trabeculotomy group and in 58% of eyes in the goniotomy group (p = 0.004). Of eyes in the trabeculotomy group, 79% had vision of 20/50 or better compared with 53% in the goniotomy group (p = 0.03). High myopia was more prevalent in the goniotomy group, but this difference was not statistically significant (p = 0.16). A poor visual outcome was associated with failure of the angle surgery or poor compliance with follow-up and amblyopia therapy. CONCLUSIONS: For primary congenital glaucoma, 360° trabeculotomy is a highly effective procedure that results in excellent pressure control and is at least as successful as multiple standard procedures. In this study, 360° trabeculotomy resulted in better vision than what is reported in the literature for standard angle procedures.
Dr. M.E. Mendicino, Department of Ophthalmology, Emory University School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Classification:
9.1.1 Congenital glaucoma, Buphthalmos (Part of: 9 Clinical forms of glaucomas > 9.1 Developmental glaucomas)
12.9 Trabeculotomy, goniotomy (Part of: 12 Surgical treatment)
