Optical Coherence Tomography Of The Irido-Corneal Angle Before And After Goniotomy And Trabeculotomy In Primary Congenital Glaucoma

Purpose: To evaluate morphological changes of the irido-corneal angle before and after angle surgery in primary congenital glaucoma (PCG) using hand-held anterior segment optical coherence tomography (HH AS-OCT) and to correlate preoperative findings with the surgical outcome.

Cairo University, children's eye hospital

This prospective, institutional study included 57 eyes of 32 infants who underwent goniotomy or trabeculotomy for PCG. Patients underwent HH AS-OCT preoperatively then postoperatively at 6 months or, in failed cases once failure criteria were reached. Cases were classified as success when the final intraocular pressure (IOP) was <18 mmHg and/or with ≥30% IOP reduction on the same or fewer number of medications.

Severity of trabeculodysgenesis was consistent with the clinical severity of the disease as age at presentation was significantly higher in the mild group (p=<0.001). The success rate of trabeculotomy was significantly higher in eyes with mild trabeculodysgenesis (p=0.01). Postoperative findings included reduction of central corneal thickness (CCT), deepening of the irido corneal angle and interruption of the hyperreflective membrane occluding the angle. A significant difference in preoperative and postoperative average iris thickness at the temporal and nasal angles was found between successful and failed trabeculotomy cases.

AS-OCT grading of trabeculodysgenesis in PCG may help predict the outcome of angle surgery. A thinner iris may be a risk factor for failure of trabeculotomy.