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Yan Shi, huaizhou wang, Ying Han, Ningli Wang; Ab interno versus ab externo microcatheter-assisted trabeculotomy for primary congenital glaucoma with clear cornea. Invest. Ophthalmol. Vis. Sci. 2020;61(7):951.
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To compare surgical outcomes of ab interno and ab externo microcatheter-assisted trabeculotomy (MAT) for primary congenital glaucoma (PCG) with clear cornea.
Consecutive patients with PCG and clear corneas underwent MAT using an ab interno approach (Group 1) or ab externo approach (Group 2) performed by the two surgeons were retrospectively enrolled. Surgical success was defined as a post-operative intraocular pressure of ≤21 mmHg with at least a 30% reduction from pre-operative IOP with or without the use of anti-glaucoma medication (qualified and complete success, respectively). Success was also defined as no additional surgical therapy, stabilized corneal diameter, and no additional optic nerve damage for at least 3 months after surgery.
A total of 115 eyes of 89 patients were included. Mean IOP at 12 months in group 1 decreased from 33.7±6.8 mmHg to 14.5±3.5 mmHg, and from 33.6±7.5 mmHg to 15.5±4.5 mmHg in Group 2 (both P<0.001). The percentage of patients with qualified and complete success was comparable between groups (qualified success: 87.9% versus 85.6%, P=0.765; complete success: 80.3% versus 78.6%, P=0.771). Complications were minimal and comparable. Less than 360 degree trabeculotomy (P=0.012) and a higher number of previous surgeries (p=0.018) were both associated with worse surgical outcomes.
Ab interno MAT provide good and similar outcomes as ab externo MAT in patients with PCG and clear corneas. It should be the initial choice in these patients. Since the first surgery performed for PCG is extremely important, these two approaches could be used to complement each other when one has failed to create enough of a trabeculotomy with either technique alone.
This is a 2020 ARVO Annual Meeting abstract.
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