Comparison of 360° circumferential trabeculotomy and conventional trabeculotomy in primary pediatric glaucoma surgery: complications, reinterventions and preoperative predictive risk factors.

PURPOSE: To quantify the postoperative complications and the need of re-operation after a single circumferential trabeculotomy versus a single conventional trabeculotomy, in 5 years follow-up, in patients who underwent primary pediatric glaucoma surgery. For each complication and each re-operation case, we calculate the risk of appearance pointing out the possible preoperative risk factors by establishing a statistical connection between the result and the values of preoperative IOP, corneal diameter, or axial length.
METHODS: This was a retrospective study of patients aged 1 day to 3 years who underwent primary pediatric glaucoma surgery. A total of 45 patients (79 eyes) were followed up for at least 5 years. There were two groups: the 360° circumferential trabeculotomy with illuminated catheter group and the conventional trabeculotomy group.
RESULTS: Hyphema was the most common post-operative complication occurring in 64 eyes (81.01%) 30 (78.95%) in the conventional group and 34 (82.93%) in the circumferential group. There have been 5 eyes (6.3%) that needed re-operation: 1 case of hypotony (7 mmHg) and 4 cases of postop hypertension, 1 case (2.43%) in the circumferential group and the rest of 4 cases (10.53%) in the conventional group.
CONCLUSIONS: A preop IOP of 25 mmHg or more in the conventional group is statistically significant predictive (p = 0.023) for postop hyphema, as well as a preop IOP of 28 mmHg or more is predictive (p = 0.02) for the need of reintervention. Circumferential trabeculotomy has better results in time, similar complications and lower failure rates meaning less eyes requiring re-operation than conventional trabeculotomy.