Cairo University Faculty of Medicine, Cairo, Egypt.
J Glaucoma. 2024 Nov 1;33(11):862-866. doi: 10.1097/IJG.0000000000002479. Epub 2024 Aug 5.
Gonioscopy-assisted transluminal trabeculotomy yielded a 45% reduction in intraocular pressure in primary congenital glaucoma, with a success rate of 86.6%. Hyphema was the most common complication. We did not encounter any vision-threatening complications.
To assess the outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in primary congenital glaucoma (PCG) and identify the potential prognostic factors for adverse outcomes.
This prospective study included patients aged <14 years, presenting with PCG from November 2019 till November 2021. We excluded eyes with hazy cornea, secondary glaucoma, peripheral anterior synechiae ≥90 degrees, and eyes in which the extent of GATT was <270 degrees. Success was defined as a final intraocular pressure (IOP) <18 mm Hg with IOP reduction >20%. Primary outcomes were reduction in IOP and medications, secondary outcomes were complications and correlation of IOP reduction and surgical success with possible risk factors.
We included 60 eyes of 50 patients aged 1-156 months (mean: 25.5±36.5). A 353±21 degrees incision was created, with 85% achieving a 360-degree incision. There was a significant reduction in IOP and medications at all follow-up intervals up to 2 years, with a mean of 45% IOP reduction. The final success rate was 86.6%, with 76.7% being controlled without medications. There was a significant positive correlation between the preoperative cup-to-disc ratio (CDR) and failure rates ( P =0.03) and between the incision extent and the IOP reduction (r=0.4, P =0.001). Hyphema was the most common complication, affecting 33%, and resolved spontaneously in all cases. No vision-threatening complications occurred.
GATT is a safe and effective procedure in eyes with PCG and clear cornea, including eyes that had previous failed glaucoma surgery. Circumferential GATT is associated with more favorable outcomes, while eyes with a larger CDR are at a higher risk for failure.
在原发性先天性青光眼患者中，房角镜辅助经巩膜小梁切开术使眼压降低了 45%，成功率为 86.6%。前房积血是最常见的并发症。我们没有遇到任何威胁视力的并发症。
评估房角镜辅助经巩膜小梁切开术（GATT）在原发性先天性青光眼（PCG）中的疗效，并确定不良预后的潜在预测因素。
本前瞻性研究纳入了 2019 年 11 月至 2021 年 11 月期间患有 PCG 的年龄<14 岁的患者。我们排除了角膜混浊、继发性青光眼、周边前粘连≥90 度以及 GATT 范围<270 度的眼。成功定义为最终眼压（IOP）<18mmHg，IOP 降低>20%。主要结局为眼压和药物的降低，次要结局为并发症和眼压降低与手术成功与可能的危险因素的相关性。
我们纳入了 50 名患者的 60 只眼，年龄 1-156 个月（平均 25.5±36.5）。创建了 353±21 度的切口，85%达到 360 度切口。在所有随访间隔直至 2 年，眼压和药物均显著降低，平均眼压降低 45%。最终成功率为 86.6%，76.7%的患者无需药物治疗即可控制眼压。术前杯盘比（CDR）与失败率之间存在显著正相关（ P =0.03），切口范围与眼压降低之间存在显著正相关（r=0.4， P =0.001）。前房积血是最常见的并发症，影响了 33%的患者，但所有病例均自发消退。没有发生威胁视力的并发症。
房角镜辅助经巩膜小梁切开术是一种安全有效的治疗原发性先天性青光眼伴透明角膜的方法，包括既往青光眼手术失败的患者。环形 GATT 与更好的结果相关，而 CDR 较大的眼发生失败的风险更高。
