Microcatheter-assisted Trabeculotomy for Primary Congenital Glaucoma after Failed Glaucoma Surgeries.

PURPOSE: To evaluate the effectiveness of microcatheter-assisted trabeculotomy (MAT) to treat primary congenital glaucoma (PCG) after failed prior glaucoma surgeries.

METHODS: Retrospective, non-comparative, interventional case series conducted at Beijing Tongren Eye Center, China. Outcome measures were compared between three groups: Successful and complete (≥330-degrees) MAT; successful and partial (<330-degrees) MAT; or cases converted to traditional trabeculotomy when Schlemm's canal could not be catheterized >180-degrees. Success was defined as final intraocular pressure ≤21▒mmHg, with (qualified success) or without (complete success) glaucoma medications.

RESULTS: Seventy-four eyes of 63 consecutive patients were included. MAT was performed in 50 eyes (67.6%). Post-operative intraocular pressure and number of glaucoma drops (17.7±8.6▒mmHg, 0.6±1.2 medications) was significantly less than the pre-operative values (35.3±7.2▒mmHg, 2.7±0.8 medications; P<0.001). Cumulative probabilities of qualified and complete success were 84.0% and 80.0% at 3-year follow-up with no difference between complete and partial trabeculotomies. MAT was not successfully performed in 24 eyes (32.4%), requiring conversion to traditional trabeculotomy and associated with greater incidence of previous surgeries (P<0.001), earlier age of disease onset (P=0.024) and worse corneal transparency (P=0.010). Cumulative probabilities of qualified and complete success were 37.0% and 29.2% at 3-year follow-up.

CONCLUSIONS: Both complete and partial MAT achieved significant pressure reduction in cases of PCG with previous failed glaucoma surgeries in intermediate-term.