Circumferential (360°) trabeculotomy in primary congenital glaucoma: 19–245 months of follow-up

Abstract

Purpose: To evaluate the long-term efficacy and safety of circumferential trabeculotomy (CT) in the treatment of primary congenital glaucoma (PCG). Methods: Retrospective, single-institutional case series of CT performed for PCG in years 1997–2016. The surgery could be completed in 42 out of 65 eyes (65%) intended for CT, and 39 of them were included in the study. A follow-up examination was performed in 2017. Success was defined as intraocular pressure ≤ 16 mmHg without (complete) or with (qualified) glaucoma medication. Results: Complete success was obtained in 33/39 eyes (85%), qualified success in 34/39 eyes (87%). Of the 39 eyes with CT, 4 eyes (10%) needed additional surgery. Median follow-up time was 120 months (range, 19–245 months). Median pre- and postoperative IOP were 26.0 mmHg (range, 10–41 mmHg) and 11.0 mmHg (range, 8–19 mmHg), respectively (p < 0.001). Cup-disc ratio was ≥0.5 in 82% at baseline, at follow-up in 9%. The median distance corrected visual acuity at follow-up was logMAR 0.06 (range, −0.2 to 1.1). Median number of glaucoma medication at follow-up was 0 (range, 0–2), at baseline 1.0 (range, 0–2). No serious complications were noted. Conclusion: Circumferential trabeculotomy is an efficacious, safe and medication saving surgical treatment for PCG in the long term. After a median follow-up of 10 years (120 months), the morphological status of the optic nerve was either normalized or stabilized, and the visual acuity overall well preserved.