Two-year results of microcatheter-assisted trabeculotomy in paediatric glaucoma: a randomized controlled study

To compare the outcomes of microcatheter-assisted circumferential trabeculotomy to standard rigid probe trabeculotomy in childhood glaucomas.

Eyes of children requiring trabeculotomy for primary congenital or secondary paediatric glaucoma were randomized to undergo either trabeculotomy using the Glaucolight illuminated microcatheter, or a rigid probe trabeculotomy. Complete success was defined as an intraocular pressure (IOP) of <18 mmHg without medications.

A total of 62 eyes of 62 patients were included. Of these 30 eyes of 30 patients aged 5.6 ± 4.8 months underwent microcatheter-assisted trabeculotomy, with 15 eyes (50%) having a complete 360° cut, while 15 eyes (50%) had an incomplete cut ranging from 250 to 350 degrees. The rigid probe trabeculotomy group included 32 eyes of 32 patients aged 4.4 ± 3.8 months. At the end of the 2-year follow-up period, the complete success and the failure rates were 67% and 15%, respectively, in the microcatheter-assisted group versus 47% and 50% in the rigid probe trabeculotomy group (p = 0.006). There was a tendency towards lower IOP in the microcatheter group at 1, 3, 6, 12 and 24 months postoperatively, with the difference in IOP reaching statistical significance at 6 months (p = 0.004). The mean survival time was significantly longer for the microcatheter group (p = 0.01).

At 2 years postoperatively, microcatheter-assisted trabeculotomy still yielded superior results in terms of IOP control and success rates in children with primary congenital glaucoma. The need for reoperation for glaucoma was significantly lower in the microcatheter group.