Surgical interventions for primary congenital glaucoma.

Area of Science:

• Ophthalmology
• Pediatric Surgery
• Glaucoma Research

Background:

• Primary congenital glaucoma (PCG) is a severe optic neuropathy causing high intraocular pressure in young children.
• PCG leads to significant morbidity, even in developed countries.
• Effective surgical management is crucial for preserving vision in affected children.

Purpose of the Study:

• To systematically compare the effectiveness and safety of various surgical techniques for primary congenital glaucoma (PCG).
• To evaluate surgical outcomes and identify optimal interventions for PCG in children under five years of age.

Main Methods:

• A comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase, PubMed, etc.) was conducted.
• Included randomized controlled trials (RCTs) and quasi-RCTs comparing surgical interventions in children under five with PCG.
• Standard Cochrane methodology was employed for data collection and analysis.

Main Results:

• Combined trabeculotomy and trabeculectomy (CTT) showed little to no difference in IOP or success compared to trabeculotomy (very low certainty evidence).
• Viscotrabeculotomy also demonstrated no significant difference from conventional trabeculotomy (very low certainty evidence).
• Microcatheter-assisted 360-degree circumferential trabeculotomy may lead to lower IOP and higher surgical success rates compared to conventional trabeculotomy (moderate certainty evidence). Hyphema was a common adverse event.

Conclusions:

• Current evidence suggests limited differences between CTT, viscotrabeculotomy, and conventional trabeculotomy for PCG.
• Microcatheter-assisted 360-degree trabeculotomy shows potential for improved outcomes.
• High-quality, multicenter trials are recommended to definitively compare PCG surgical interventions.