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Microcatheter-assisted Trabeculotomy for Primary Congenital Glaucoma After Failed Glaucoma Surgeries

Hu, Man, MD*,†; Wang, Huaizhou, MD, PhD*; Huang, Alex S., MD, PhD; Li, Li, MD; Shi, Yan, MD*; Xu, Yongli, PhD§; Wang, Ningli, MD, PhD*

doi: 10.1097/IJG.0000000000001116
Original Studies

Purpose: To evaluate the effectiveness of microcatheter-assisted trabeculotomy (MAT) to treat primary congenital glaucoma after failed previous glaucoma surgeries.

Materials and Methods: Retrospective, noncomparative, interventional case series conducted at Beijing Tongren Eye Center, China. Outcome measures were compared between 3 groups: successful and complete (≥330 degrees) MAT; successful and partial (<330 degrees) MAT; or cases converted to traditional trabeculotomy when the Schlemm’s canal could not be catheterized >180 degrees. Success was defined as final intraocular pressure ≤21 mm Hg, with (qualified success) or without (complete success) glaucoma medications.

Results: In total, 74 eyes of 63 consecutive patients were included. MAT was performed in 50 eyes (67.6%). Postoperative intraocular pressure and number of glaucoma drops (17.7±8.6 mm Hg, 0.6±1.2 medications) was significantly less than the preoperative values (35.3±7.2 mm Hg, 2.7±0.8 medications; P<0.001). Cumulative probabilities of qualified and complete success were 84.0% and 80.0% at 3-year follow-up with no difference between complete and partial trabeculotomies. MAT was not successfully performed in 24 eyes (32.4%), requiring conversion to traditional trabeculotomy and associated with greater incidence of previous surgeries (P<0.001), earlier age of disease onset (P=0.024) and worse corneal transparency (P=0.010). Cumulative probabilities of qualified and complete success were 37.0% and 29.2% at 3-year follow-up.

Conclusions: Both complete and partial MAT achieved significant pressure reduction in cases of primary congenital glaucoma with previous failed glaucoma surgeries in intermediate term.

*Beijing Tongren Eye Center, Beijing Tongren Hospital

National Key Discipline of Pediatrics, Ministry of Education, Department of Ophthalmology, Beijing Children’s Hospital, Capital Medical University

§Department of Mathematics, Beijing University of Chemical Technology, Beijing, China

Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA

Partially supported by the Beijing Municipal Science &Technology Commission, PR China (grant number is Z161100000516081) and National Natural Science Foundation of China (grant number is 11571031). Partially supported by RPB Career Development Award (AH) and NIH K08EY024674 (AH).

Disclosure: The authors declare no conflict of interest.

Reprints: Ningli Wang, MD, PhD, Beijing Tongren Hospital, 1 Dongjiaominxiang Street, Dongcheng District, Beijing 100730, China (e-mail: wningli@vip.163.com).

Received August 17, 2018

Accepted October 8, 2018

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