Trabeculotomy Versus Combined Trabeculotomy-Trabeculectomy for Management of Primary Congenital Glaucoma

Precis: Trabeculotomy (T) alone is as safe and effective as combined trabeculotomy-trabeculectomy (TT) in patients with primary congenital glaucoma (PCG) and requires significantly fewer examinations under anesthesia in the postoperative period. Purpose: The purpose of this study was to compare the outcomes of T and combined TT as the initial surgical procedure for patients with PCG. Methods: In this retrospective study, medical records of patients who had undergone T or TT as the initial procedure for PCG were reviewed. The primary outcome measure was a surgical success, defined as 5 <= intraocular pressure (IOP) <= 21 mm Hg, IOP reduction of at least 20% with no need for further glaucoma surgery. Secondary outcome measures were the number of glaucoma medications and complications. Results: A total of 134 eyes from 134 patients with a mean follow-up of 8 +/- 6.6 years were included consisting of 106 and 28 eyes, which had undergone T and TT, respectively. Success rates were comparable with both surgical procedures at 1, 2, 3, 4, and 5 years with no statistically significant difference. IOP was significantly decreased from 27.5 +/- 4.2 mm Hg preoperatively to 15.62 +/- 3.4 mm Hg at the 5-year follow-up visit in the T group and from 25.3 +/- 6.5 to 17.1 +/- 3.2 mm Hg in the TT group (P=0.1) there was no significant difference between the 2 groups in the number of glaucoma medications (P=0.2). Patients in the T group required significantly fewer examinations under anesthesia than the TT group (7.3 +/- 4.4 vs. 10.1 +/- 3.9, P=0.04). Conclusion: Trabeculotomy alone seems as effective as combined trabeculotomy-trabeculectomy and may significantly reduce exposure to anesthesia in primary congenital glaucoma patients.