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Alina Djougarian, Craig H Marcus, Robert Rothman, Allison Angelilli, Daniel Hayes; Comparison of surgical outcomes between 360 degree and traditional 180 degree trabeculotomy in patients with congenital glaucoma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2731.
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To compare operative outcomes of patients after 360 degree catheter assisted with traditional trabeculotomy through 24 months of follow-up in patients with congenital glaucoma.
Retrospective, nonrandomized study of patients with congenital who underwent 360 degree catheter assisted trabeculotomy (T360) or 180 degree trabeculotomy (T180) to control intraocular pressure (IOP) between April 2000 and July 2014. Age ranged from birth to 72 months (mean 9.1 months). Diagnosis included: primary congenital glaucoma and secondary glaucomas.
30 eyes of 19 patients with congenital glaucoma were analyzed up to 24 months. Follow-up ranged from 6 to 132 months (mean 61.3 months). 4 patients were followed for less than one year. No differences were found with respect to gender in the post-operative IOPs (p<0. 3739). At 24 months mean number of drops required were 0.97 for T180 and 0.52 for T360 (p<0.0171). IOP reduction was 50.6% for T180 and 62.6% for T360 (p<0.6417). 40% of patients with T180 required re-operation (Baerveldt glaucoma implant, repeat 180 degree trabeculotomy/trabectome, deep sclerectomy/trabeculotomy). 13.3% of patients with T360 required reoperation (goniotomy). Rates of re-operation between 2 groups were not statistically significant (p<0.2148). In primary congenital glaucoma patients only, IOP reduction was 60.4% for T180 and 63.9% for T360 (p<0.4817). 18% of eyes in T180 group required re-operation (deep sclerostomy/viscocanalostomy). 11.1% patients required re-operation in T360 (goniotomy). IOPs from 6 to 24 months were lower in primary congenital glaucoma patients treated with either T180 or T360 compared to patients with secondary congenital glaucoma treated with either T180 or T360 (p<0.1187).
T360 achieved lower IOPs from months 6 to 24 for all congenital glaucoma patients as well as the subset of primary congenital glaucoma patients, although not statistically significant. T360 required fewer medications. Though not reaching statistical significance, T360 had a lower rate of reoperation. T360 attained as good results as T180 and offered the clinical advantage of not requiring a second trabeculotomy. Further collective results of other investigators will help refine the most advantageous approach to congenital glaucomas.
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