Microcatheter-Assisted Trabeculotomy Versus Circumferential Trabeculotomy with the Rigid Probe Trabeculotome in Pediatric Glaucoma
Yasmine M. El Sayed; Ghada I. Gawdat
Cairo University Hospital
Introduction: The study compares outcomes of microcatheter-assisted trabeculotomy to circumferential trabeculotomy using the rigid probe trabeculotome in primary congenital glaucoma (PCG).
Methods: The medical records of PCG patients that underwent circumferential trabeculotomy (>/= 270° incised)using Glaucolight illuminated microcatheter or a rigid probe trabeculotome in the pediatric ophthalmology unit of Cairo University Hospital were reviewed. The primary outcomes were the percent reduction of intraocular pressure (IOP) and success rates.Complete success was defined as IOP<18mmHg without medications. Secondary outcomes were the postoperative IOP and glaucoma medications.
Results: The study included 92 eyes of 92 patients.Of these 33 eyes of 33 patients aged 6.4 ± 8.7 months underwent microcatheter-assisted trabeculotomy, with 19 eyes (58%) having a complete 360°cut. While 59 eyes of 59 patients aged 8.2 ± 13.1 months had 2-site trabeculotomy using a rigid probe trabeculotome through a combined superonasal and inferotemporal approach,with 33 eyes (56%) having a complete cut. After a follow up period of 21.2 ± 8.9 months, there was a 42±25% IOP reduction and 73% rate of complete success in the microcatheter group,compared to 40 ± 22% IOP reduction and 80% success rate in the rigid probe group (P-value=0.7 and 0.3,respectively).There was no significant difference in survival time in both groups (P=0.6)
Discussion: Circumferential trabeculotomy using either the illuminated microcatheter or rigid probe trabeculotome yielded comparable results in terms of surgical success, IOP and medications.
Conclusion: Both techniques are recommended as an initial surgical procedure in primary congenital glaucoma yet the added cost of the microcatheter should be considered.
References: Girkin CA, Rhodes L, McGwin G, Marchase N, Cogen MS. Goniotomy versus circumferential trabeculotomy with an illuminated microcatheter in congenital glaucoma. J AAPOS 2012; 16:424-427
Al-Hazmi A, Awad A, Zwaan J, Al-Mesfer S A, Al-Jadaan I, Al-Mohammed A. Correlation between surgical success rate and severity of congenital glaucoma. Br J Ophthalmol 2005; 89:449-453.