Viscocanalostomy combined with nearly 360-degree suture trabeculotomy for the treatment of primary congenital glaucoma: a preliminary report of a novel technique for trabeculotomy

Abstract

Purpose: The aim of this study was to determine the preliminary efficacy and safety of a novel technique for trabeculotomy for the treatment of primary congenital glaucoma (PCG).

Methods: This retrospective interventional study was conducted on patients with PCG. Pliability test was performed among 5/0 and 6/0 polypropylene sutures and the flexible illuminated microcatheter. Viscocanalostomy was first performed and the Schlemm's canal was identified. Then, suture trabeculotomy was completed except the region for viscocanalostomy. The preoperative and follow-up data were recorded and analyzed. Success criteria were defined as intraocular pressure (IOP) ≤ 21 mmHg without (complete success) or with medications (qualified success).

Results: 5/0 polypropylene suture was an appropriate option for cannulation of Schlemm's canal. A total of 33 eyes from 23 consecutive patients were included with a mean follow-up of 9.3 ± 3.6 months (range 6-18 months). Circumferential cannulation by suture was successfully performed in 28 eyes (84.8%) of 18 patients. Mean IOP decreased from 33.9 ± 9.4 mmHg preoperatively to 10.5 ± 3.5 mmHg at 6 months (p < 0.001) and 11.3 ± 4.1 mmHg at 9 months (p < 0.001). Complete success rate was 92.9% [95% confidence interval (CI:0.83-1.03)] and 87.5% (CI:0.69-1.06) at 6 months and 9 months, respectively. Hyphema was found in 5 eyes (17.9%), all of which were absorbed within 1 week. No other complications were observed.

Conclusions: Viscocanalostomy combined with nearly 360-degree suture trabeculotomy as a novel technique controls IOP in patients with PCG without any severe complications. It is suitable for extended applications because of accurate identification of Schlemm's canal and low cost.

Keywords: Primary congenital glaucoma; Schlemm’s canal; Suture trabeculotomy; Viscocanalostomy.