Long-term surgical and visual outcomes in primary congenital glaucoma: 360° trabeculotomy versus goniotomy

Abstract Purpose: To compare the visual outcome and refractive status of children with primary congenital glaucoma who underwent 360° trabeculotomy or goniotomy as an initial surgical procedure. Methods: This retrospective study describes 24 eyes (15 patients) with primary congenital glaucoma that underwent 360° trabeculotomy as the initial procedure and 40 eyes (23 patients) that underwent goniotomy as the initial procedure. Inclusion criteria were: (1) diagnosis of primary congenital glaucoma and initial angle surgery before 1 year of age, (2) no other ocular or systemic diseases, (3) 360° trabeculotomy or goniotomy as the first surgical procedure, and (4) ability to obtain an Allen or Snellen visual acuity. A postoperative vision of 20/50 or better was considered good. Surgical success was defined as an intraocular pressure (IOP) less than 22 mm Hg with or without medication and without evidence of a progressive optic neuropathy. Results: The IOP was successfully controlled in 92% of eyes in the trabeculotomy group and in 58% of eyes in the goniotomy group ( P =.004). Of eyes in the trabeculotomy group, 79% had vision of 20/50 or better compared with 53% in the goniotomy group ( P =.03). High myopia was more prevalent in the goniotomy group, but this difference was not statistically significant ( P =.16). A poor visual outcome was associated with failure of the angle surgery or poor compliance with follow-up and amblyopia therapy. Conclusion: For primary congenital glaucoma, 360° trabeculotomy is a highly effective procedure that results in excellent pressure control and is at least as successful as multiple standard procedures. In this study, 360° trabeculotomy resulted in better vision than what is reported in the literature for standard angle procedures. (J AAPOS 2000;4:205–10)