Trabeculotomy versus Trabeculectomy for Primary Congenital Glaucoma

The aim of this study was to compare the visual acuity and intraocular pressure (IOP) in children who underwent either trabeculotomy or trabeculectomy as an initial surgical procedure for primary congenital glaucoma.This retrospective study involved 38 eyes (21 patients) with primary congenital glaucoma treated by trabeculotomy and 45 eyes (26 patients) that underwent trabeculectomy. The inclusion criteria were: (i) diagnosis of primary congenital glaucoma and initial surgery before 1 year of age, (ii) no other ocular or systemic diseases, (iii) trabeculotomy or trabeculectomy as the first surgical procedure, and (iv) conditions permitting the assessment of visual acuity. A postoperative vision of 6/18 or better was considered a good outcome. Surgical success was defined as IOP less than 21 mmHg with or without medication and without evidence of glaucoma-associated, progressive optic neuropathy. All children were followed up for 3 to 10 years. IOP was successfully controlled in 89% of the trabeculotomy group eyes and in 54% of the eyes in the trabeculectomy group (P = 0.007). In the trabeculotomy group, 74% eyes had a corrected vision of 6/18 or better compared with 51% in the trabeculectomy group (P = 0.027). It was concluded that, at long-term follow-up, trabeculotomy appeared to be a more effective procedure than standard trabeculectomy for treatment of primary congenital glaucoma, because it gave better outcomes in terms of IOP control and visual acuity.