Risk Factors for Trabeculotomy Failure in Primary Congenital Glaucoma.

PRCIS: This study demonstrates that a baseline corneal diameter >12.25, initial age <4 months at diagnosis, higher baseline IOP than 24 mm Hg, bilaterality, or inability to perform circumferential trabeculotomy, increases the risk of surgical failure of trabeculotomy in patients with primary congenital glaucoma (PCG). PURPOSE: The aim of this study was to identify clinical predictive factors for surgical failure and to evaluate potential prognostic factors affecting surgical success in patients with PCG who underwent trabeculotomy. PATIENTS AND METHODS: The medical charts of 123 eyes of 75 patients who underwent trabeculotomy surgery for the treatment of PCG were retrospectively reviewed. At baseline and each visit, intraocular pressure (IOP), corneal diameter, cup to disc ratio, axial length, number of medications, and need for further glaucoma surgery were noted. Surgical success was defined as an IOP ≤18 mm Hg and 20% IOP reduction from baseline with (qualified) or without (complete) medication and without any further IOP-lowering surgery. RESULTS: The mean age at surgery was 4.2±6.6 months and the mean follow-up time was 60.0±37.6 months. The receiver operating characteristic curve showed 4 following best cutoff values to predict surgical failure: the first for age at surgery was 4.5 months; the second baseline IOP was 24.0 mm Hg; the third for baseline cup to disc ratio was 0.4; and the fourth for baseline corneal diameter was 12.25 mm. Multivariate logistic regression analysis revealed that baseline IOP more than 24 mm Hg increased the risk of surgical failure by 2 times, baseline mean corneal diameter >12.25 mm did by 4.2 times, younger age than 4 months did by 2.5 times, bilaterality did by 1.5 times. CONCLUSIONS: A higher baseline IOP, younger age, larger corneal diameter, and bilaterality were identified as risk factors for trabeculotomy failure in congenital glaucoma. The presence of one or more of these should be considered in the decision-making process when considering surgical options to manage glaucoma in these patients.

Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy in Vitrectomized Patients With Secondary Glaucoma After Silicone Oil Removal.

PRCIS: The present study demonstrates that surgical success rates of gonioscopy-assisted transluminal trabeculotomy (GATT) with a target intraocular pressure (IOP)≤21 mm Hg are 93.3% (for qualified success) and 26.7% (for complete success) in vitrectomized patients exhibiting secondary open-angle glaucoma (SOAG) after silicone oil (SO) removal, for an average follow-up of 37.5 months. PURPOSE: To report the long-term outcomes of GATT in vitrectomized patients exhibiting SOAG after SO removal. SETTING: Retrospective case-series study. PATIENT POPULATION: This retrospective case-series study enrolled vitrectomized patients who underwent uneventful GATT surgery between May 2014 and May 2019 at Gazi University Hospital for the treatment of medically uncontrolled SOAG after SO removal. MAIN OUTCOME MEASURES: At baseline and at each postoperative visit, a detailed ophthalmic examination consisting of slit-lamp biomicroscopy, indirect ophthalmoscopy, macular optical coherence tomography, and Goldmann applanation tonometry was performed in all patients. Baseline demographic and clinical characteristics, duration between pars plana vitrectomy and SO removal, duration between SO removal and onset of SOAG, follow-up time, need for antiglaucoma medication, visual acuity, and IOP measurements were noted. Surgical success was defined as an IOP≤21 and ≥6 mm Hg with (qualified success) and without (complete success) IOP-lowering medication. RESULTS: A total of 15 patients had a history of pars plana vitrectomy with 1000 centistoke SO tamponade before the GATT surgery. GATT was performed in all patients with SOAG after SO removal. The mean age and follow-up of the patients were 53.6±11.8 years (range, 34 to 72 y) and 37.5±15.1 months (range, 12 to 61 mo), respectively. The average duration of SO tamponade in the vitreous cavity was 7.5±1.6 months (range, 5 to 10 mo). The average duration between the SO removal and the development of SOAG was 14.1±13.2 months (range, 2 to 46 mo). The mean IOP decreased from 31.0±4.1 mm Hg at baseline to 15.6±4.6 mm Hg at final visit. The mean final logMAR BCVA was 0.92±0.58 (range, 2 to 0.045). Qualified surgical success was achieved in 14 (93.3%) patients, whereas complete success was achieved in only 4 (26.7%) patients (P<0.001). CONCLUSIONS: GATT seems to be safe and successful procedure for controlling IOP in patients exhibiting SOAG after SO removal. However, most patients may require antiglaucoma medication during the follow-up, particularly within the first 2 postoperative years.