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Effectiveness of 360 degree trabeculotomy in childhood glaucoma

Anna T Do, Eleni Drivas, Arkadiy Yadgarov, Sonal Dangda, Paul A Sidoti, Kateki Vinod, Doug Fredrick, Joseph F Panarelli

Purpose: To evaluate the effectiveness and safety of illuminated-microcatheter-assisted trabeculotomy in patients with childhood glaucoma.

Patients and methods: A retrospective chart review was conducted to identify all patients with childhood glaucoma who underwent ab externo illuminated microcatheter-assisted trabeculotomy by a single surgeon between October 2013 and June 2017. Baseline characteristics, pre- and post-operative intraocular pressures (IOP), medication use, surgical details and complications were recorded. Success was defined as an IOP>5 mmHg and<21 mmHg (with or without medications), without the need for additional glaucoma surgery.

Results: A total of 28 eyes of 22 patients were included with an average age of 3.90 ± 5.24 years (median 1 year). Mean IOP reduction after trabeculotomy was 14.0 ± 6.92 mmHg, representing a 43.7% overall reduction (p<0.001). IOP was successfully reduced by at least 20% from baseline in 24 of 28 eyes (85.7%). Medication usage decreased by 1.07 ± 1.18 medications (p<0.001). Patients with primary congenital glaucoma (PCG) had a higher success rate (92.3%) compared to patients with other types of glaucoma (53.3%) at their most recent follow up (average 21.8 months, range 6-53 months). Seven eyes (25%) required additional surgery for inadequate IOP control, all of which underwent placement of a glaucoma drainage implant.

Conclusion: Illuminated microcatheter-assisted trabeculotomy is an effective and safe option for the management of childhood glaucoma. Patients with PCG have significantly higher success rates compared to patients with other types of childhood glaucoma.