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Published on: October 13, 2017
Combined nasal goniotomy - temporal trabeculotomy (NGTT) for circumferential angle surgery in primary congenital
Ahmed Mostafa Abdelrahman1, Rana Hussein Amin1
1Kasr Al-Aini Hospital - 63526Cairo University, Cairo, Egypt.
Insights
Nasal goniotomy and temporal trabeculotomy effectively reduced intraocular pressure in infants with primary congenital glaucoma, maintaining results for up to 18 months. This combined surgical approach offers a safe and viable option for managing infantile glaucoma.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Research
Background:
- Primary congenital glaucoma (PCG) is a severe form of infantile glaucoma.
- Effective surgical management is crucial for preserving vision in affected infants.
- Preserving conjunctival tissue for future surgeries is a key consideration in PCG management.
Purpose of the Study:
- To evaluate the safety and efficacy of a combined nasal goniotomy and temporal trabeculotomy (NGTT) procedure.
- To assess the impact of NGTT on intraocular pressure (IOP) in infants with PCG.
- To determine the long-term outcomes and conjunctival sparing benefits of the NGTT procedure.
Main Methods:
- A case series involving fifteen eyes of eleven infants diagnosed with PCG.
- The combined nasal goniotomy and temporal trabeculotomy surgery was performed, aiming for 360-degree angle circumference.
- The superior conjunctiva was intentionally preserved to facilitate potential future glaucoma surgeries.
Main Results:
- Significant IOP reduction averaging 60% from pre-operative levels was observed and sustained up to 18 months post-surgery.
- Complete surgical success was achieved in 93.3% of eyes, with minor complications in 26.6% that did not impact IOP outcomes.
- Mean IOP remained significantly lower throughout the follow-up period (p < 0.0001), with only one eye requiring additional surgery.
Conclusions:
- Combined nasal goniotomy and temporal trabeculotomy (NGTT) is a safe and effective surgical technique for managing primary congenital glaucoma.
- The procedure achieves significant and sustained IOP reduction while preserving conjunctival tissue for future interventions.
- NGTT represents a valuable addition to the surgical options for infantile glaucoma, offering circumferential angle surgery benefits.
Purpose:
To assess the safety and efficacy of combining nasal goniotomy with temporal trabeculotomy in the management of primary congenital glaucoma.
Design:
Case series.
Methods:
Fifteen eyes of eleven children (3-12 months old at presentation) were enrolled in this study after the establishment of PCG diagnosis based on the criteria placed by the World Glaucoma Association. Combined nasal goniotomy and temporal trabeculotomy were done on each eye in an attempt to perform almost 360 degrees circumferential angle surgery without disturbing the superior 180 degrees of conjunctiva to preserve it for future filtering glaucoma surgeries.
Results:
By first month, average IOP was 10.5 ± 4.3 mmHg with a 65.3% reduction from average pre-operative IOP. Almost the same percentage of reduction was maintained at 3rd,6th and 12th months postoperative visits with average IOP of 11.9 ± 4.65, 11.8 ± 2.77 and 13 ± 2.82 mmHg (60.7%, 61.1% and 57.2% reduction from pre-operative average). According to success rates, complete success has been achieved in all eyes but one (93.3%), with minor complications in 4 out of 15 eyes (26.6%) that did not affect IOP outcome. Nine out of fifteen eyes completed 18 months post-operative follow-up visits with a successfully, maintained target average IOP of 13.3 ± 3.0 mmHg (57.2% reduction). All of the mean IOP readings during post-operative follow-up period were significantly lower when compared to pre-operative IOP (p < 0.0001). Only one eye had persistently elevated IOP of 26 mmHg at 1st and 3rd months post-operatively that necessitated a subsequent subscleral trabeculectomy which succeeded in controlling the pressure bringing it down to 15 mmHg on topical medications.
Conclusion:
Nasal goniotomy - temporal trabeculotomy (NGTT) is the combination of two well established surgeries that exploits the advantages of circumferential angle surgery while sparing the superior conjunctiva completely for future surgeries if needed. This new procedure was safe and effective in lowering IOP by an average of 60% from pre-operative IOP with a sustained effect till 18 months post-operatively. We believe that this surgery might be added to the armentarium of the surgical management of infantile glaucomas with other circumferential angle surgeries.
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