Trabeculotomy Versus Combined Trabeculotomy-Trabeculectomy for Management of Primary Congenital Glaucoma

Yazdani, Shahin; Pakravan, Mohammad; Gerami, Ebrahim; Doozandeh, Azadeh; Esfandiari, Hamed; Sharifipour, Farideh

doi:10.1097/ijg.0000000000001981

Cited by 6 publications

(3 citation statements)

References 22 publications

(58 reference statements)

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“…In the TRAB group of the current series, we had 7 patients with history of failed trabeculectomy before initial AGV surgery who satis ed all success criteria at the end of follow-up. This nding is different from results from previously published studies reporting lower success with repeat trabeculectomy (29)(30)(31).…”

Section: Discussioncontrasting

confidence: 99%

Failed Ahmed Glaucoma Valves: Trabeculectomy versus Repeat Shunt Surgery

Einollahi,

Doozandeh,

Sharifipour

et al. 2024

Preprint

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Introduction: To investigate the outcomes of trabeculectomy (TRAB) versus repeat Ahmed glaucoma valve (re-AGV) implantation in eyes with Ahmed glaucoma valve (AGV) failure. Methods: This quasi-experimental study reports patients with AGV failure requiring additional surgical intervention between 2018 and 2022. Patients in the TRAB group underwent a fornix-based procedure with mitomycin C 0.01% injection (0.1 mL). Eyes in the re-AGV group underwent repeat shunt surgery. The choice of the procedure was based on surgeon’s discretion. The primary outcome measure was surgical success rates based on various intraocular pressure (IOP) targets and percentages of reduction from baseline: IOP ≤ 21 mmHg and 20% reduction (conventional criteria), IOP ≤ 18 and 20% reduction (criterion A), IOP ≤ 15 and 25% reduction (criterion B), and IOP ≤ 12 and 30% reduction (criterion C). Results: Forty-eight eyes of 48 patients are reported herein, consisting of 22 eyes of 22 patients undergoing TRAB and 26 eyes of 26 subjects undergoing re-AGV. No significant difference was observed between the study groups in terms of initial diagnoses, baseline IOP or the number of prior surgeries. The cumulative probability of survival at one year was significantly higher in the trabeculectomy group using the three stricter success definitions. In both study groups, IOP was significantly reduced from baseline at all postoperative visits, and was significantly lower in the TRAB group at all time points beyond one month. At 12 months, 5% of TRAB versus 48% of re-AGV eyes required glaucoma medications (P<0.001). The rate of complications was comparable between the study groups (P=0.76) but there was a trend toward a greater need for repeat surgery in the re-AGV group (4 eyes versus nil, P=0.07). Conclusions: Trabeculectomy can be considered a safe and effective surgical option in eyes with failed AGV leading to significantly lower IOP levels and more favorable success rates than re-AGV in selected patients.

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Section: Discussioncontrasting

confidence: 99%

Failed Ahmed Glaucoma Valves: Trabeculectomy versus Repeat Shunt Surgery

Einollahi,

Doozandeh,

Sharifipour

et al. 2024

Preprint

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“…Studies have evaluated different surgical procedures, such as trabeculotomy, trabeculectomy, and goniotomy, for treating PCG; these procedures are the most common treatments for this condition [ 5 – 7 ]. Unlike in Western countries, preferred interventions have not demonstrated favorable outcomes in Saudi Arabia, including goniotomy, trabeculotomy, and trabeculectomy [ 8 – 11 ]. Conversely, nonpenetrating deep sclerectomy (NPDS) has demonstrated promising outcomes, improving the safety of conventional filtering procedures [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Trabeculodescemetic Window Perforation in Deep Sclerectomy on Intraocular Pressure in Primary Congenital Glaucoma

AlQattan,

Schargel,

AlJadaan

et al. 2024

Ophthalmol Ther

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Introduction Primary congenital glaucoma causes vision loss if intraocular pressure is uncontrolled. Nonpenetrating deep sclerectomy is effective in treating primary congenital glaucoma. However, the effects of inadvertent trabeculodescemetic window perforation remain unclear. Methods This retrospective cohort study included patients with primary congenital glaucoma who underwent nonpenetrating deep sclerectomy between 2014 and 2021. The perforation group had intraoperative trabeculodescemetic window perforations; the non-perforation group did not. The primary outcome was intraocular pressure between the groups over 15 months. The secondary outcomes included surgical success and complications. Results The study included 74 eyes of 44 patients. The cohort comprised 31 perforated and 43 non-perforated eyes. Both groups showed significant intraocular pressure reduction without significant between-group differences in complete (68 vs. 77%), qualified (19 vs. 9%), or failed (13 vs. 14%) treatments. The median intraocular pressure decreased from 39 to 14 mmHg in the perforation group and 35 to 12 mmHg in the non-perforation group. Of the 74 treated eyes, 68 (92%) showed no complications. Conclusions An inadvertent trabeculodescemetic window perforation during nonpenetrating deep sclerectomy for primary congenital glaucoma did not significantly affect intraocular pressure outcomes compared to non-perforated cases over 15 months. Nonpenetrating deep sclerectomy reduced intraocular pressure regardless of intraoperative perforation in patients with primary congenital glaucoma. Perforation of the trabeculodescemetic window was associated with a low incidence of postoperative complications.

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“…We read with great interest this important study by Yazdani et al,1 comparing 2 important surgical procedures for managing primary congenital glaucoma, and thank the authors for reporting this. The optimum management regarding angle surgery alone compared with combined trabeculectomy and trabeculotomy has often been debated.…”

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confidence: 96%