1 Hospital Divino Espirito Santo de Ponta Delgada; Centro Hospitalar de Lisboa Central;
2 Serviço de Oftalmologia, Centro Hospitalar de Lisboa Central;
3 Centro Hospitalar do Baixo Vouga; Centro Hospitalar de Lisboa Central;
4 Oftalmologia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central.
- European Paediatric Ophthalmological Society (EPOS) Annual Meeting, Leiden, Outubro de 2013
Introduction: Primary congenital glaucoma (PCG) is a relatively rare disease but an important cause of blindness. Treatment is mainly surgical and management is challenging. The purpose of this study is to compare outcome and complications of goniotomy or trabeculotomy for the treatment of PCG.
Methods: Retrospective case series analysis of patients with primary congenital glaucoma submitted to a goniotomy or a trabeculotomy, as the initial surgical procedure within the first year of age. A postoperative vision of 20/40 or better was considered good. Surgical success was defined as an intraocular pressure (IOP) <21 mmHg with at least a 30% reduction from preoperative pressure levels, without the need of other surgical procedures, at 5-year follow-up. Complete success was defined when target IOP was reached without the use of antiglaucoma medication, and qualified success was defined when antiglaucoma drops were required to achieve this level of IOP.
Results: A total of 20 eyes (12 patients) were submitted to goniotomy and 10 eyes (6 patients) to trabeculotomy. Of eyes in the goniotomy group, 30% had good vision compared with 40% in the trabeculotomy group. High myopia was more prevalent in the trabeculotomy group (50%) comparing to goniotomy (20%). Trabeculotomy demonstrated a 20% qualified and 30% unqualified success rate with 5-year follow-up, comparing to 20% qualified and 20% unqualified success rate of goniotomy. A case of significant transitory hyphema was registered in the trabeculotomy group and there were no complications in the goniotomy group.
Conclusion: In primary congenital glaucoma, trabeculotomy appears to be as safe and effective as goniotomy within five years after surgery. Our study suggests that both procedures are still valid alternatives in the surgical management of this disease.