From Conventional Angle Surgery to 360-Degree Trabeculotomy in Pediatric Glaucoma

Area of Science:

• Ophthalmology
• Pediatric Glaucoma Surgery

Background:

• Conventional angle surgery (CAS) for pediatric glaucoma includes rigid probe trabeculotomy or goniotomy.
• Evaluating the efficacy of newer techniques is crucial for improving surgical outcomes in children.

Purpose of the Study:

• To compare the outcomes of microcatheter-assisted 360-degree trabeculotomy (MCT) with conventional angle surgery (CAS) in pediatric glaucoma patients.
• To describe the transition from CAS to MCT in a clinical setting.

Main Methods:

• A retrospective comparative interventional case series was conducted.
• 106 eyes of 77 children with glaucoma who underwent angle surgery between January 2012 and March 2018 were reviewed.
• Success was defined as intraocular pressure (IOP) ≤21 mm Hg with ≥20% IOP reduction and no further glaucoma surgery.

Main Results:

• Microcatheter-assisted 360-degree trabeculotomy (MCT) demonstrated significantly higher qualified success rates (85% vs. 37%) and complete success rates (69% vs. 23%) compared to conventional angle surgery (CAS).
• MCT resulted in a lower need for further glaucoma surgery (5.5% vs. 63.4%) and a trend towards greater IOP reduction (52.1% vs. 45.5%).
• No significant complications were observed in either group, and MCT showed a favorable change in axial length compared to CAS.

Conclusions:

• Microcatheter-assisted 360-degree trabeculotomy (MCT) is a more effective surgical option for pediatric glaucoma than conventional angle surgery (CAS).
• The transition to MCT is feasible and beneficial, even for complex cases or those with prior surgeries, offering improved success rates and reduced reoperation needs.