Performing viscocanalostomy plus trabeculotomy (VCO+tbo) may be a viable option for children with primary congenital glaucoma (PCG) and a history of failed trabeculotomy, according to research published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus.

Investigators performed VCO+tbo on 75 eyes of 46 patients with PCG who experienced poor outcomes following 1 angle surgery. They defined a successful outcome as achieving a postoperative intraocular pressure (IOP) reading of 6-21 mm Hg and a 20% or greater decrease in IOP, with (qualified) or without (complete) the use of glaucoma medications.

Mean follow-up was 31±11 months, and participants achieved complete success in 8% of eyes and qualified success in 51% of eyes. IOP decreased from a preoperative average of 29.0±5.8 to 15.7±2.6 mm Hg in successively treated eyes, and the average number of medications decreased from 2.6±0.9 to 2.0±1.0 in successfully treated eyes as well (P <.001).


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The success rate of the combined intervention was lower in patients with neonatal disease onset compared with individuals experiencing onset between 1 and 12 months of age (HR=0.22; P =.039). Children diagnosed after 1 year responded better to the intervention than participants with neonatal onset, but worse than individuals aged between 1 and 12 months. However, this difference only trended toward statistical significance. 

Researchers noted hyphema in 36% of eyes on day 1 following treatment, and it resolved on its own in 100% of cases. Only 1 eye exhibited iatrogenic cyclodialysis, which was surgically repaired.

“Because angle surgery with or without nonpenetrating glaucoma surgery is associated with fewer complications than filtration procedures, it may be worth trying in these children before attempting more risky intervention,” according to the investigators.

Limitations of the study include the absence of a control group, small sample size, and failure to perform gonioscopic examination on all participants. 

Reference

Vahedian Z, Fakhraie G, Ahmed AH. Viscocanalostomy combined with trabeculotomy for management of refractory primary congenital glaucoma. J AAPOS. Published online April 14, 2022. doi:10.1016/j.jaapos.2021.12.010.