Elwehidy Ahmed Samy, Elhofi AbdElhamid Shaker, Abdelkader Amr Mohammed Elsayed, GabAllah Nada Medhat
Department of Ophthalmology, Mansoura University, Mansoura.
Department of Ophthalmology, Alexandria University, Alexandria, Egypt.
J Glaucoma. 2025 Oct 1;34(10):811-818. doi: 10.1097/IJG.0000000000002608. Epub 2025 Jul 10.
Both Gonioscopy-assisted transluminal trabeculotomy and ab externo visco circumferential suture trabeculotomy reduced the intraocular pressure in primary congenital glaucoma by more than 50% from baseline at 2 years. There were no serious adverse events.
Primary congenital glaucoma (PCG) is a severe form of glaucoma that presents in infancy and requires surgical intervention to prevent irreversible vision loss. Angle-based surgery is the primary treatment for PCG, with recent reports suggesting promising outcomes for gonioscopy-assisted transluminal trabeculotomy (GATT) in children with PCG. Ab externo visco circumferential suture trabeculotomy (AVCST) offers the advantages of combining the efficacy of 360-degree circumferential trabeculotomy through low-cost Prolene sutures with the facilitation of the Schlemm's canal (SC) cannulation using viscoelastic.
This retrospective interventional study compared the 1-year outcomes of GATT and AVCST in managing PCG. The records of 65 eyes of 39 children who underwent surgery for their PCG were reviewed.
The key outcome measures included reduction of intraocular pressure (IOP), the success rate, and surgical complications. At 2 years, both surgical techniques demonstrated significant IOP reduction from baseline (GATT: mean reduction of 15.33±2.56 mmHg; AVCST: mean reduction of 15.96±2.95 mmHg) but there was no statistical difference between both groups at 2 years ( P =0.371). The complete success rate, defined as an IOP ≤16 mmHg with > 30% reduction from the baseline without antiglaucoma medications (AGMs) or further surgical interventions, was 87.1% for the GATT and 85.3% for the AVCST, which was not statistically significant between the 2 groups ( P =0.710). The complication rates were comparable between the 2 groups, with transient hyphaema being the most common adverse event.
Our findings indicate that GATT and AVCST are both effective and safe surgical options for PCG, with similar efficacy and complication profiles after 2 years. Further long-term studies are warranted to assess the durability of these outcomes.
房角镜辅助经腔小梁切开术和外路粘弹剂环形缝线小梁切开术均可使原发性先天性青光眼患者的眼压在2年时较基线水平降低50%以上。未发生严重不良事件。
原发性先天性青光眼（PCG）是一种严重的青光眼类型，在婴儿期发病，需要手术干预以防止不可逆的视力丧失。基于房角的手术是PCG的主要治疗方法，最近的报告表明房角镜辅助经腔小梁切开术（GATT）在PCG患儿中取得了有前景的结果。外路粘弹剂环形缝线小梁切开术（AVCST）具有以下优点：通过低成本的普理灵缝线进行360度环形小梁切开术，同时利用粘弹剂便于施累姆管（SC）插管。
这项回顾性干预性研究比较了GATT和AVCST治疗PCG的1年结果。回顾了39例接受PCG手术的儿童的65只眼的记录。
主要结局指标包括眼压降低、成功率和手术并发症。在2年时，两种手术技术均显示眼压较基线水平显著降低（GATT：平均降低15.33±2.56mmHg；AVCST：平均降低15.96±2.95mmHg），但两组在2年时无统计学差异（P=0.371）。完全成功率定义为眼压≤16mmHg且在未使用抗青光眼药物（AGM）或未进行进一步手术干预的情况下较基线水平降低>30%，GATT组为87.1%，AVCST组为85.3%，两组之间无统计学差异（P=0.710）。两组的并发症发生率相当，短暂性前房积血是最常见的不良事件。
我们的研究结果表明，GATT和AVCST都是治疗PCG有效且安全的手术选择，2年后疗效和并发症情况相似。需要进一步进行长期研究以评估这些结果的持久性。
