Combined Nasal Goniotomy-Temporal Trabeculotomy Versus Temporal Trabeculotomy for Management of Primary Congenital Glaucoma

Overview

Combined nasal goniotomy and temporal trabeculotomy provides effective IOP control in PCG while preserving the superior conjunctiva for future filtering procedures. By expanding the treated angle area and sparing the superior conjunctiva, this operation provides a synergistic approach that may improve long-term management strategies for pediatric glaucoma

Primary congenital glaucoma (PCG) is the main category of primary childhood glaucoma. Classically, PCG presents with one or more of the following clinical manifestations: increased corneal diameters, corneal opacification, photophobia, and excessive tearing. The increased intraocular pressure (IOP) in PCG is mainly due to an immature anterior chamber (AC) angle with inadequate aqueous filtration through the trabecular meshwork (TM). 1 Reduction of IOP in PCG relies mainly on surgical treatment. Wide variations in surgical procedures exist for the treatment of PCG, with different principles and steps. The idea behind angle-based surgeries is to remove the main barrier to aqueous filtration and create a direct pathway for aqueous to reach the Schlemm's Canal (SC). Other surgeries, such as trabeculectomy or implantation of Glaucoma drainage devices (GDD), divert the aqueous drainage toward the sub-tenon space away from the occluded TM.2,3 and 4 PCG treatment may entail the need for more than one surgery to correct the IOP. Combining two or more surgical procedures in the same setting may produce a synergistic effect in reducing the IOP while reducing the psychological and surgical burden on PCG patients. In the combined Nasal Goniotomy-Temporal Trabeculotomy (NGTT) procedure, preservation of the superior conjunctiva is an advantage that increases the success rates of further surgeries if needed. 5 In this study, the authors studied a real-world comparison between NGTT and single-site trabeculotomy for the management of PCG patients.

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Eligibility

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Outcomes