The following is the summary of “Risk Factors for Trabeculotomy Failure in Primary Congenital Glaucoma” published in the December 2022 issue of Glaucoma by Aktas, et al.
Baseline corneal diameter more than 12.25, initial age less than 4 months at diagnosis, baseline IOP 24 mm Hg, bilaterality, or incapacity to conduct circumferential trabeculotomy all enhance the probability of surgical failure of trabeculotomy in patients with primary congenital glaucoma (PCG), as shown by this study. The goals of this study were to uncover clinical predicting variables for surgical failure and analyze potential prognostic factors impacting surgical outcome in patients with PCG who underwent trabeculotomy.
Medical records for 123 eyes of 75 patients who had trabeculotomy surgery to treat PCG were reviewed retrospectively. Intraocular pressure (IOP), corneal diameter, the cup-to-disc ratio, axial length, the number of drugs, and the need for additional glaucoma surgery were all recorded at the first visit and at each subsequent one. Having an intraocular pressure (IOP) of ≤18 mm Hg or less and a 20% decrease in IOP from baseline without the use of medication (qualifying) or medication (complete) were considered successful surgical outcomes. The average age at surgery was 4.2±6.6 months, and the average follow-up period was 60.0±37.6 months. Baseline cup-to-disc ratio of 0.4, baseline corneal diameter of 12.25 mm, and age at surgery of 4.5 months were the best cutoff values for predicting surgical failure, as shown by the receiver operating characteristic curve.
According to multivariate logistic regression analysis, baseline intraocular pressure (IOP) greater than 24 mm Hg doubled the risk of surgical failure, while baseline mean corneal diameter more than 12.25 mm increased the risk by 4.2 times, while age less than 4 months increased the risk by 2.5 times, and bilaterality increased the risk by 1.5 times. Trabeculotomy failure in congenital glaucoma has been linked to greater baseline IOP, younger age, larger corneal diameter, and bilaterality. When deciding between surgical treatments for glaucoma, the existence of one or more of these should be taken into account.