Surgical outcomes after trabeculotomy for primary congenital glaucoma

To investigate outcomes after trabeculotomy in Japanese patients with primary congenital glaucoma (PCG), and to identify risk factors for multiple glaucoma surgery procedures.

Retrospective observational study.

Surgical outcomes were investigated in Japanese patients with PCG who underwent their first glaucoma surgery at Hiroshima University Hospital between January, 2006, and December, 2021. The data included in this study were divided into single- and multiple-surgery groups, and risk factors for requiring multiple surgery procedures were evaluated using multivariate analysis.

Twenty eyes of 20 patients were included. All eyes underwent ab externo trabeculotomy as the first surgery. The mean follow-up period was 75.7 ± 44.8 months. The cumulative success rate for up to 3 trabeculotomies at 5 years after the first surgery was 89.7%. The glaucoma in 11 eyes (55.0%) was controllable with just one surgery, whereas 9 eyes (45.0%) required 2 or more glaucoma surgical procedures. The single-surgery group had a significantly better mean best-corrected visual acuity at the last visit than the multiple-surgery group (0.1 ± 0.1 versus 0.9 ± 1.1, respectively, p = 0.001) and a smaller mean cylindrical power (- 0.8 ± 0.8 versus - 2.2 ± 1.0, respectively, p = 0.01). In multivariate logistic analysis, a 1-mm increase in corneal diameter was associated with a 16-fold increase in the risk of multiple glaucoma surgical procedures (p = 0.047).

The glaucoma in most PCG eyes can be controlled with up to three trabeculotomies. Corneal-diameter enlargement was a significant risk factor for multiple surgical procedures.