Efficacy of Catheter Assisted 360° Trabeculotomy in Primary Congenital Glaucoma (PCG)

Abstract

Purpose: To assess the efficacy of catheter assisted 360° trabeculotomy in PCG patients.

Methods: Retrospective review of all primary congenital glaucoma patients treated between June 2008 and November 2012 at 2 sites. Parameters analyzed included intraocular pressure, number of pre- and post-op glaucoma medications, cup-to-disc ratio. Failure was defined as the need for additional surgery. Paired t-test was performed to determine whether surgery was successful in reducing the intraocular pressure (IOP).

Results: 18 eyes from 11 patients were identified that underwent catheter assisted 360° trabeculotomy for PCG. At the time of surgery, patients were (mean ± SD) 5.2 ± 2.6 months of age and post-operative follow up was 1.7 ± 1.7 years. Mean IOP was reduced (p< 0.05) by 15.2 ± 10.1 mmHg, and remained consistently reduced over the 1.7 ± 1.7 follow up years. 6 eyes showed a decrease in the cup to disc ratio. The number of glaucoma medications decreased from 1.2 ± 1.1 prior to surgery to 0.7± 0.9 medications after surgery. The reduction of glaucoma medications remained steady throughout follow up. No ocular or systemic complications were reported postoperatively. 22% (4/18) of the eyes required additional surgery. In these 4 patients glaucoma drainage devices were the subsequent procedure.

Conclusions: Catheter assisted 360° trabeculotomy effectively reduced intraocular pressure in 94% of eyes included in the study. Surgery was successful in 78% of the eyes, and was associated with a reduction in topical glaucoma therapy in patients with congenital glaucoma over nearly a 2 year follow-up.

Keywords: 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • 735 trabecular meshwork • 633 outflow: trabecular meshwork