PURPOSE To compare the efficacy of circumferential gonioscopy-assisted transluminal trabeculotomy (GATT) versus hemi-GATT in primary congenital glaucoma (PCG). DESIGN Prospective randomized controlled trial METHODS: This study included children with PCG having corneal diameters <14mm and relatively clear cornea. Based on randomisation, the eyes included, underwent either circumferential GATT (360-GATT) or hemi-GATT (180-GATT). The intra-ocular pressure (IOP) reduction, requirement for glaucoma medications after surgery, need for repeat surgery and the incidence and type of complications in each group were analysed. Surgical success was defined as absolute when IOP ≤18 (criterion A) and ≤15mmHg (criterion B) was achieved without medications and qualified when the same was achieved with pressure-lowering medications. Eyes with an IOP ≥18mmHg on maximum medications, those with IOP <6 mmHg or need for further intervention for IOP control were considered failures. RESULTS Fifty-two eyes of children with PCG were randomized into either the 360-GATT group (22 eyes) or the 180-GATT group (30 eyes) and followed up for at least 1 year. The median follow-up duration was 22.5 months (range: 12-30 months). IOP fell by 49% and 20.5% with 360-GATT and 180-GATT respectively, final IOP being significantly lower in the former group (p=0.0003). For absolute success the cumulative survival was superior with 360-GATT for both criterion A and B at 1 year (p=0.009). Average cup disc ratio, corneal diameter and axial length reversal were significant in the 360-GATT group but not in the hemi-GATT group. CONCLUSIONS This study reinforces the superior efficacy of circumferential GATT for IOP control in eyes with congenital glaucoma.

中文翻译：

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先天性青光眼圆周与半侧房角镜辅助腔内小梁切开术的结果。


目的 比较环状房角镜辅助腔内小梁切开术 （GATT） 与半 GATT 治疗原发性先天性青光眼 （PCG） 的疗效。设计 前瞻性随机对照试验 方法： 本研究包括角膜直径 <14mm 且角膜相对清晰的 PCG 患儿。根据随机化，包括眼睛在内的眼睛接受了圆周 GATT （360-GATT） 或半 GATT （180-GATT）。分析每组眼压 （IOP） 降低、术后对青光眼药物的需求、重复手术的需要以及并发症的发生率和类型。当在没有药物的情况下达到 IOP ≤18（标准 A）和 ≤15mmHg（标准 B）时，手术成功被定义为绝对成功，当使用降压药物达到相同时，手术成功被定义为合格。最大药物治疗下 IOP ≥18mmHg 的眼睛、IOP <6 mmHg 或需要进一步干预以控制 IOP 的眼睛被认为是失败的。结果 52 只 PCG 患儿的眼睛被随机分为 360-GATT 组 （22 只眼） 或 180-GATT 组 （30 只眼） 并随访至少 1 年。中位随访时间为 22.5 个月 （范围： 12-30 个月）。360-GATT 和 180-GATT 的 IOP 分别下降了 49% 和 20.5%，前一组的最终 IOP 显着降低 （p=0.0003）。对于绝对成功，标准 A 和 B 在 1 年时 360-GATT 的累积生存率均优于 360-GATT （p = 0.009）。360-GATT 组平均杯盘比值、角膜直径和眼轴长度反转显著，而 hemi-GATT 组不显著。结论 本研究加强了周向 GATT 对先天性青光眼眼 IOP 控制的优越疗效。