Trabeculectomy Alone Is an Effective First Intervention for Primary Congenital Glaucoma

Typically, treatment for primary congenital glaucoma (PCG) begins with angle surgery, which is repeated if the first procedure fails. Then, ophthalmologists traditionally try trabeculectomy or combined trabeculotomy-trabeculectomy. However, research published in the Journal of Glaucoma suggests that stand-alone trabeculotomy is an effective initial intervention for PCG that also reduces patients’ exposure to anesthesia.

An increasingly more aggressive approach to treating PCG is standard procedure, starting with angle surgery and ending with cyclodestructive procedures for refractory or very advanced cases. However, according to researchers, a timely surgical approach can help preserve visual function and patients’ quality of life.

Researchers conducted a retrospective study to compare the outcomes of using trabeculotomy as the initial surgical intervention for patients with PCG or trabeculotomy-trabeculectomy. They reviewed medical records for 134 eyes from 134 patients with a mean follow-up of 8±6.6 years. Of the group, 106 patients had trabeculotomy, while 28 patients had the combination procedure.

Success rates were comparable for both approaches at 1, 2, 3, 4 and 5 years. However, researchers noted higher success rates throughout the study for patients who only underwent trabeculotomy, but the difference was not statistically significant. More specifically, intraocular pressure (IOP) significantly decreased from 27.5±4.2 mmHg preoperatively to 15.62±3.4 mm Hg at the 5-year follow-up visit in the single-procedure group and from 25.3±6.5 to 17.1±3.2 mm Hg in the dual-procedure group (P =.1). There was no significant difference between the 2 groups in the number of glaucoma medications, according to investigators (P =.2). Patients in the trabeculotomy-only group required significantly fewer examinations under anesthesia than the trabeculotomy-trabeculectomy group (7.3±4.4 vs 10.1±3.9, P =.04).

Limitations of this study include its retrospective design, an uneven number of cases in the study groups, varying durations of follow-up, and the use of a variety of instruments to measure IOP during follow-up. 

Reference

Yazdani S, Pakravan M, Gerami E, et al. Trabeculotomy versus combined trabeculotomy-trabeculectomy for management of primary congenital glaucoma. J Glaucoma. Published online January 10, 2022. doi:10.1097/IJG.00000000000019