Viscocanalostomy combined with trabeculotomy for management of refractory primary congenital glaucoma

PURPOSE To investigate the outcome of viscocanalostomy combined with trabeculotomy (VCO+tbo) in primary congenital glaucoma (PCG) with history of failed trabeculotomy. METHODS In this prospective study, VCO+tbo was performed in 75 eyes of 46 patients with PCG who had not responded adequately to one angle surgery. Success was defined as intraocular pressure (IOP) of 6-21 mm Hg and at least 20% IOP drop at the last postoperative visit with (qualified) or without (complete) glaucoma medications. RESULTS Patients completed a mean follow-up of 31 +/- 11 months. Complete success was achieved in 6 eyes (8%); qualified success, in 38 eyes (51%). In the 44 successfully treated eyes, IOP was reduced from a preoperative mean of 29.0 +/- 5.8 to 15.7 +/- 2.6 mm Hg, and the number of medications dropped from 2.6 +/- 0.9 to 2.0 +/- 1.0 (P<0.001). In univariate analysis, the success rate was lower in patients with neonatal onset disease than subjects whose age at onset was 1-12 months (HR=0.22; 95% CI, 0.05-0.93; P=0.039). Children whose disease was first diagnosed after 1 year of age responded better than neonatal onset patients but worse than those with age of onset of 1-12 months; however, the difference was not statistically significant. Hyphema occurred in 27 eyes (36%) on day 1 and resolved spontaneously. Iatrogenic cyclodialysis occurred in one eye, which was surgically repaired after 1 month of treatment with cycloplegic agents. CONCLUSIONS In our study cohort, VCO+tbo was associated with successful outcomes in the majority of treated eyes.