Two-Site Trabeculotomy vs. Gonioscopy-Assisted Transluminal Trabeculotomy in the Treatment of Primary Congenital Glaucoma: A Randomized Prospective Study.

PURPOSE

The aim of this study was to compare the outcomes of 2-site rigid probe trabeculotomy (RPT) compared to gonioscopy-assisted transluminal trabeculotomy (GATT) in the treatment of primary congenital glaucoma (PCG).

DESIGN

A prospective randomized controlled study

SUBJECTS

The study included 77 eyes of 60 patients with PCG with clear corneas all aged < 5 years.

METHODS

Patients were randomized to undergo either 2-site trabeculotomy using a RPT or GATT using a 5/0 polypropylene suture. Success was defined as achieving a final intraocular pressure (IOP) < 18 mmHg without (complete) or with medications (qualified).

MAIN OUTCOME MEASURES

Primary outcomes were reduction of IOP and medications. Secondary outcomes were complications and success rates. Anterior segment OCT (AS-OCT) was performed to compare changes in angle morphology.

RESULTS

The two-site RPT group included 39 eyes, and the GATT group included 38 eyes. There was a significant reduction in IOP and glaucoma medications at 1, 3, 6, 9, and 12 months postoperatively in both groups (P < 0.001) with no significant difference in IOP or IOP-lowering medications between both groups at any follow-up (FU). At the final FU, there was a 49% ± 13% IOP reduction in the 2-site RPT trabeculotomy group compared to 44% ± 25% in the GATT group (P = 0.2). Success was achieved in all eyes in the RPT group and in 95% in the GATT group. Hyphema was the most frequently observed complication; with no vision-threatening complications in either group. Postoperative AS-OCT findings included angle widening, trabecular shelf, and peripheral anterior synechia.

CONCLUSIONS

Circumferential trabeculotomy using ab interno GATT or ab externo 2-site trabeculotomy yielded comparable results in terms of safety and efficacy. Gonioscopy-assisted transluminal trabeculotomy has the advantage of sparing the conjunctiva which may be needed for future interventions. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.