Circumferential (360°) trabeculotomy in primary congenital glaucoma: 19–245 months of follow‐up

PURPOSE: To evaluate the long‐term efficacy and safety of circumferential trabeculotomy (CT) in the treatment of primary congenital glaucoma (PCG). METHODS: Retrospective, single‐institutional case series of CT performed for PCG in years 1997–2016. The surgery could be completed in 42 out of 65 eyes (65%) intended for CT, and 39 of them were included in the study. A follow‐up examination was performed in 2017. Success was defined as intraocular pressure ≤ 16 mmHg without (complete) or with (qualified) glaucoma medication. RESULTS: Complete success was obtained in 33/39 eyes (85%), qualified success in 34/39 eyes (87%). Of the 39 eyes with CT, 4 eyes (10%) needed additional surgery. Median follow‐up time was 120 months (range, 19–245 months). Median pre‐ and postoperative IOP were 26.0 mmHg (range, 10–41 mmHg) and 11.0 mmHg (range, 8–19 mmHg), respectively (p < 0.001). Cup‐disc ratio was ≥0.5 in 82% at baseline, at follow‐up in 9%. The median distance corrected visual acuity at follow‐up was logMAR 0.06 (range, −0.2 to 1.1). Median number of glaucoma medication at follow‐up was 0 (range, 0–2), at baseline 1.0 (range, 0–2). No serious complications were noted. CONCLUSION: Circumferential trabeculotomy is an efficacious, safe and medication saving surgical treatment for PCG in the long term. After a median follow‐up of 10 years (120 months), the morphological status of the optic nerve was either normalized or stabilized, and the visual acuity overall well preserved.