Non-penetrating deep sclerectomy versus combined trabeculotomy–trabeculectomy in primary congenital glaucoma

Abstract Background: The primary mode of therapy in children with primary congenital glaucoma (PCG) and mild or no corneal edema is goniotomy, which has a high success rate. However, in developing countries, the diagnosis of PCG is usually delayed, and corneal cloudiness interferes with goniotomy. Therefore, trabeculotomy may be the best choice in such eyes. We compared the short-term efficacy and safety of primary combined trabeculotomy–trabeculectomy (primary CTT) with that of non-penetrating deep sclerectomy (NPDS) in managing PCG. Methods: This prospective, randomized, comparative study included patients with PCG referred to Al-Azhar University Hospitals within a ۱-year period. Eyes were randomly allocated to one of two groups: eyes in NPDS group underwent NPDS, and those in primary CTT group underwent primary CTT. Baseline and frequent postoperative assessments of intraocular pressure (IOP), cup-to-disc ratio (C/D ratio), corneal diameter, and axial length were performed for up to ۶ months. The success rates were recorded in both groups. Results: Forty eyes of ۲۶ patients were included, with ۲۰ eyes allocated to each group. The mean (standard deviation) age of all patients was ۱۲.۹ (۹.۵) months, with comparable ages and sex ratios between groups (both P > ۰.۰۵). Both groups demonstrated a significant reduction in IOP and C/D ratio at each postoperative visit compared to the baseline visit (all P < ۰.۰۰۱), with no significant difference detected between the groups (all P > ۰.۰۵), except for a significantly lower IOP in NPDS group at ۱ month (P < ۰.۰۵). The corneal diameter and axial length were comparable between groups at baseline and remained unchanged at all postoperative visits (all P > ۰.۰۵). The groups had comparable success rates (P > ۰.۰۵). No serious complications were detected. Conclusions: CTT and NPDS both yielded reasonable IOP control and reversal of cupping in eyes with PCG. We observed equal effectiveness of the surgical procedures without major safety concerns. Further large-scale clinical trials with longer follow-up periods are needed to verify our preliminary findings.