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Monisha Mandalaywala Vora, Craig Marcus, Robert Rothman, Daniel Hayes, Allison Angelilli; Comparison of surgical outcomes between 360 degree catheter assisted and traditional 180 degree trabeculotomy in patients with congenital glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4749.
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To compare operative outcomes of patients after 360 degree catheter assisted with traditional trabeculotomy through 12 months follow up.
Retrospective, nonrandomized, comparative study of patients with congenital glaucoma seen by the Glaucoma Consultants of Long Island who underwent 360 degree catheter assisted or 180 degree trabeculotomy to control intraocular pressure (IOP) between April 2000 and July 2012. All surgeries were performed by one of the listed authors.
We included 14 separate eye surgeries of 8 patients who underwent 360 degree trabeculotomy, and 7 eye surgeries of 5 patients who underwent 180 degree trabeculotomy. All 12 patients were followed for a minimum of 12 months. The absolute length of follow up was 7.4 (±2.1) years in the 180 group and 1.3 (±1.4) years in the 360 group. One patient had a 360 degree procedure in one eye and 180 degree in the fellow eye. No differences were found with respect to age at diagnosis (P=0.02) or at surgery (P=0.49), gender (P=0.26), right versus left eye (P=1.00). The mean percentage reduction in IOP from preop values at 12 months after surgery was 54.7% (±19.4) for the 360 group compared with 49.6% (±14.1) for the 180 group (P = 0.70). A higher percentage of patients treated with 360 versus 180 (57.1% vs. 35.7) required postop medications, although this did not attain significance (P=0.39). Hyphema (7.1%) was the most common postop complication seen in patients undergoing 180-degree trabeculotomy. No complications were reported in the 360 degree group. Of the 14 surgeries in the 180 group, 5 required reoperation, which included Baerveldt glaucoma implant (2), a repeat 180 degree trabeculotomy followed by a trabectome (1), and deep sclerostomy/viscocanalostomy (2). Of the 7 surgeries included in the 360 group, 1 required reoperation (goniotomy). Failure was based on the absolute number of reoperations, since this may be more predictive in this population as compared to adults.
In our small study sample, both 360 degree catheter assisted and traditional 180 degree trabeculotomy achieve significant IOP reduction at 12 months for patients with congenital glaucoma. In our sample, 360 degree trabeculotomy had lower rates of reoperation as compared to the traditional 180. However, these results need to be confirmed by a prospective, randomized, longitudinal study.
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