Combined Surgical Approach Delivers Promising Results for Congenital Glaucoma

Primary trabeculotomy and primary combined trabeculotomy-trabeculectomy (CTT) produce high long-term treatment success rates for patients of Asian ethnicity with primary congenital glaucoma (PCG), according to research published in the Journal of Glaucoma.

For the past few decades, surgical options for treating PCG have evolved. In this study, most patients underwent goniotomy and CTT from 2001 to 2010, while trabeculotomy and trabeculectomy became more popular after 2011. Treating PCG using goniotomy and trabeculotomy has had varying degrees of success. In contrast, “excellent results” have been observed with primary trabeculectomy and primary trabeculotomy, according to researchers. However, evidence among Asian populations has been limited.

Overall postoperative surgical success rates of initial procedures for our PCG patients were moderate at year 1 (68.8%) and gradually decreased to 53.7% by year 5.

Researchers examined 81 eyes from 55 patients with PCG. Among the group, 20 goniotomies, 15 trabeculotomies, 16 trabeculectomies, 15 CTT, and 15 diode transscleral cyclophotocoagulations were performed. The median follow-up time was 24 months (IQR 9 to 60 months). Overall success rates were 68.8% at 1 year, 63.8% at 3 years, and 53.7% at 5 years, according to investigators. 

More specifically, cumulative success rates of trabeculotomy (80.05%) and CTT (79.4%) were maintained at 3 and 5 years and were the highest among all procedures at 5 years. On the other hand, diode transscleral cyclophotocoagulation had a significantly lower success rate than other surgery types (HR 7.4 to 13.1, all P =.01). In fact, no patients who received primary diode transscleral cyclophotocoagulation maintained optimal intraocular pressure at 48 months.

However, even the successful procedures were not without complication. The most common early complications were hypotony and hyphema, according to researchers. Early hypotony was found most often in patients who underwent trabeculectomy. Hyphema was most prevalent in the trabeculotomy group. Late complications included a late hypotony eye and an eye of corneal decompensation in the CTT group, and a phthisis eye after in a patient who underwent diode transscleral cyclophotocoagulation.

“It should be emphasized that our objective was not to postulate that one surgery outperformed the other,” according to investigators. “PCG is a complex disease, and many factors affect the course of disease and treatment outcomes. In addition, surgical options partly rely on unique clinical conditions. Thus, the interpretation of the comparative results in this context is limited.”

The study’s authors note some limitations of their work, including its retrospective design and variations in surgical techniques, examination techniques, management trends, intraocular pressure measurement methods, surgical devices and success criteria. In addition, the study did not control for surgeon experience. Additional limitations include the inability to fully evaluate visual acuity outcomes or outcomes by disease severity and the study’s limited number of cases.

Reference

Suvannachart P, Supawan S, Chansangpetch S, et al. Outcomes of surgical interventions in primary congenital glaucoma patients. J Glaucoma. Published online January 20, 2022. doi:10.1097/IJG.0000000000001980