Efficacy Of Combined Deep Sclerectomy And Trabeculotomy In The Management Of Primary Congenital Glaucoma After Failed Previous Angle Surgeries

 Purpose: To evaluate the outcomes of combined deep sclerectomy and trabeculotomy in the management of primary congenital glaucoma after failed previous trabeculotomy and goniotomy.

Benha University

Methods: The study was conducted in the Glaucoma Unit at Benha university. The study included ten eyes of eight patients diagnosed with primary congenital glaucoma who had failed previous temporal trabeculotomy and nasal goniotomy. The mean age at the time of surgery was 2.9 ±1.3 years. All eyes had deep sclerectomy & trabeculotomy in the upper nasal quadrant augmented with mitomycin C (0.3 mg/mL for 3 min). The follow-up period was six months with a record of IOP, the number of medications used postoperatively and postoperative complications.

Results:   All operated eyes showed a reduction of IOP from 32.3 ±1.9 mmHg preoperatively to 12.33± 1.2 mmHg postoperatively, with an average decrease of 66.6% by the end of the follow-up period. The mean number of preoperative IOP lowering drops was 2.75 ± 0.89. By the end of the 6-month follow-up period, all patients needed no IOP-reducing drops. No sight-threatening postoperative complications were recorded.

Conclusion: Combined trabeculotomy and deep sclerectomy is a safe and effective surgery for the management of primary congenital glaucoma after failed previous angle surgeries. That combination has the advantage of being a non-penetrating surgery, and it also saves the upper temporal conjunctiva for potential future surgeries.