Outcomes and Anatomical Predictors of Failure of Repeat Angle Surgery After Failed Initial Surgery for Primary...

Repeat angle surgery demonstrates high success after failed initial surgery for PCG; however, a patent primary trabeculotomy incision independently predicts failure, suggesting distal outflow immaturity as a limiting factor.

To evaluate the outcomes of repeat angle surgery in eyes with primary congenital glaucoma (PCG) following failure of initial surgical intervention and to identify factors associated with surgical success or failure.

This retrospective cohort study included 28 eyes of 26 patients with PCG who underwent repeat angle surgery after failed primary surgery. Surgical success was defined as intraocular pressure (IOP) ≤16 mmHg with or without medications and without additional glaucoma surgery. Clinical and anatomical factors were evaluated as potential predictors of outcome.

At a median follow-up of 14 months (range, 9-36), repeat angle surgery achieved an overall success rate of 85.7%. Four eyes (14.3%) failed within the first postoperative month, after which survival remained stable. Eyes demonstrating abnormalities in the angle of the anterior chamber, such as peripheral anterior synechiae or incomplete trabecular meshwork cleavage, responded favorably to repeat surgery. Failure despite a clinically patent trabeculotomy incision (4 eyes) was associated with a higher likelihood of repeat surgical failure.

Repeat angle surgery is an effective option after failed primary surgery in PCG, particularly in eyes with identifiable angle pathology. Early failure despite a patent trabeculotomy incision may suggest resistance beyond the trabecular meshwork and may predict limited response to further angle-based procedures. Careful anatomical assessment may help guide selection of repeat angle surgery versus alternative surgical approaches in these cases.