Trabeculotomy using an illuminated microcatheter in primary congenital glaucoma: a prospective study

Session Details

Session Title: Glaucoma II

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 08:06

Venue: Boulevard F (Level 1)

First Author: : G.Gawdat EGYPT

Co Author(s): :    Y. El Sayed              

Abstract Details

Purpose:

To evaluate the efficacy of performing circumferential trabeculotomy using the Glaucolight (DORC, the Netherlands) in primary congenital glaucoma. The primary outcome measure was the intraocular pressure reduction. The secondary outcome measure was the development of complications.

Setting:

Cairo University Hospital

Methods:

This prospective study included patients diagnosed with primary congenital glaucoma. In all eyes a 360° trabeculotomy was attempted using the Glaucolight illuminated microcatheter. A rectangular scleral flap was created in the inferotemporal or superonasal quadrant. Schlemm’s canal was located, cannulated by a trabeculotome and 2 mm of the canal was deroofed using a superblade. Sodium hyaluronate (Hyaluron-Visc, Dorc, the Netherlands) was injected into each cut end of the canal. The microcatheter was then inserted through one of the cut ends and threaded circumferentially through the canal until coming out of the opposite cut end. The two exposed ends of the microcatherter were then grasped and pulled in opposite direction, thus incising Schlemm’s canal over 360°. In cases where the microcatheter reached an obstruction or became misdirected, the conjunctiva was dissected and a scleral cut down was created over the illuminated tip of the microcatheter. The catheter was then grasped and its two ends pulled, partially incising Schlemm’s canal. Trabeculotomy was then continued by a trabeculotome in the other ends of Schlemm’s canal under the dissected scleral flaps. All surgeries were done by one of two surgeons. Eyes in which trabeculotomy involved ≤180° of Schlemm’s canal were excluded.

Results:

A total of 26 eyes of 20 patients aged 19 days to 51.2 months (mean 6.5±10.2 months) were included. On average 328° ± 40° of Schlemm’s canal was cannulated and incised (Range 250°-360°). In 13 eyes (50%) a complete -360°- trabeculotomy was achieved. The reduction in intraocular pressure (IOP) was statistically significant at 1, 3 and 6 months (P<0.0001). Although there was a trend towards more IOP reduction in eyes that had 360° trabeculotomy compared to those that had less than 360° incised, the difference did not reach statistical significance (P=0.27, 0.45 and 0.32 at 1, 3 and 6 months respectively). Three eyes (11.5%) developed postoperative hyphema and 1 eye (3.8%) had postoperative shallowing of the anterior chamber. Both complications resolved spontaneously.

Conclusions:

Trabeculotomy using an illuminated microcatheter is a safe and effective procedure in primary congenital glaucoma. The extent of trabeculotomy did not significantly affect the outcome. It would be useful to compare the results to those of standard, 180° trabeculotomy using the trabeculotome, in a larger number of eyes, to study whether the extent of trabeculotomy influences the outcome.

Financial Interest:

NONE