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Objective
To investigate the efficacy and safety of non-penetrating trabecular surgery combined with nearly 360-degree suture trabeculotomy for the treatment of primary congenital glaucoma (PCG).
Methods
An observational case series study was conducted.A total of 29 cases (50 eyes) with PCG, including 21 males (35 eyes) and 8 females (15 eyes), were enrolled in Jiangsu Province Hospital and Nanjing Children’s Hospital from January to November, 2019.The age of subjects ranged from 1 month to 4 years, and the median age was 6 months.Non-penetrating trabecular surgery was first performed in order to open the Schlemm canal.The cannulation and nearly 360-degree suture trabeculotomy were then performed with the twisted 6-0 polypropylene suture.Intraocular pressure (IOP), corneal diameter, cup-to-disc ratio (c/d) and complications were recorded preoperatively and 1 week, 1 month, 3 months, 6 months, 9 months, 12 months, and 24 months postoperatively, and the proportion of sutures successfully passed through the Schlemm canal and the success rate of operation were recorded.This study followed the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of The First Affiliated Hospital of Nanjing Medical University (No.2019-SR-198). Written informed consent was obtained from the guardian of each subject prior to entering the study cohort.
Results
Circumferential cannulation by suture was successfully performed in 90% of the subjects.The Harms trabeculotomy probe was applied in failed cases.Mean IOP was significantly lowered from preoperative (35.0±9.5) mmHg (1 mmHg=0.133 kPa) to (9.9±4.4), (10.0±4.2), (9.7±4.4), (9.0±2.9), (9.4±4.2), (9.3±3.3) and (9.5±3.8) mmHg at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively (F=141.56, P<0.01). Mean corneal diameter was significantly reduced from preoperative (13.7±1.4) mm to (13.3±1.4), (12.9±1.4), (12.8±1.3), (12.7±1.2), (12.6±1.1), (12.6±1.1) and (12.8±0.4) mm at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively (F=4.55, P<0.01). Mean c/d was significantly reduced from preoperative 0.81±0.15 to 0.55±0.22, 0.48±0.23, 0.45±0.22, 0.43±0.21, 0.41±0.20, 0.40±0.21 and 0.31±0.19 at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively (F=21.07, P<0.01). Forty-two eyes (93.3%) achieved complete success and 45 eyes (100%) achieved qualified success at postoperative 12 months.No severe complications were observed during or after surgery.
Conclusions
Non-penetrating trabecular surgery combined with nearly 360-degree suture trabeculotomy can effectively treat patients with PCG without any severe complications.
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Contributor Information
Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
Department of Ophthalmology, Children’s Hospital of Nanjing Medical University, Nanjing Children’s Hospital, Nanjing 210008, China
Department of Ophthalmology, Children’s Hospital of Nanjing Medical University, Nanjing Children’s Hospital, Nanjing 210008, China
Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
Ji Fangfang is working in the Second Affiliated Hospital of Soochow University, Suzhou 215000, China
Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
Non-penetrating trabecular surgery combined with suture trabeculectomy for primary congenital glaucoma
The patient was a 2-month-old boy with primary congenital glaucoma. The preoperative intraocular pressure was 28 mmHg, and corneal diameter was 13 mm, cup-to-disc ratio was 0.7. The canal of Schlemm was opened via non-penetrating trabecular surgery, then the cannulation with the twisted 6-0 polypropylene suture and nearly 360-degree suture trabeculotomy were then performed.