Combined nasal goniotomy – temporal trabeculotomy (NGTT) for circumferential angle surgery in primary congenital glaucoma

Purpose To assess the safety and efficacy of combining nasal goniotomy with temporal trabeculotomy in the management of primary congenital glaucoma. Design Case series Methods Fifteen eyes of eleven children (3–12 months old at presentation) were enrolled in this study after the establishment of PCG...

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Veröffentlicht in:European journal of ophthalmology 2022-11, Vol.32 (6), p.3470-3475
Hauptverfasser: Abdelrahman, Ahmed Mostafa, Amin, Rana Hussein
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Amin, Rana Hussein
description Purpose To assess the safety and efficacy of combining nasal goniotomy with temporal trabeculotomy in the management of primary congenital glaucoma. Design Case series Methods Fifteen eyes of eleven children (3–12 months old at presentation) were enrolled in this study after the establishment of PCG diagnosis based on the criteria placed by the World Glaucoma Association. Combined nasal goniotomy and temporal trabeculotomy were done on each eye in an attempt to perform almost 360 degrees circumferential angle surgery without disturbing the superior 180 degrees of conjunctiva to preserve it for future filtering glaucoma surgeries. Results By first month, average IOP was 10.5 ± 4.3 mmHg with a 65.3% reduction from average pre-operative IOP. Almost the same percentage of reduction was maintained at 3rd,6th and 12th months postoperative visits with average IOP of 11.9 ± 4.65, 11.8 ± 2.77 and 13 ± 2.82 mmHg (60.7%, 61.1% and 57.2% reduction from pre-operative average). According to success rates, complete success has been achieved in all eyes but one (93.3%), with minor complications in 4 out of 15 eyes (26.6%) that did not affect IOP outcome. Nine out of fifteen eyes completed 18 months post-operative follow-up visits with a successfully, maintained target average IOP of 13.3 ± 3.0 mmHg (57.2% reduction). All of the mean IOP readings during post-operative follow-up period were significantly lower when compared to pre-operative IOP (p 
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Design Case series Methods Fifteen eyes of eleven children (3–12 months old at presentation) were enrolled in this study after the establishment of PCG diagnosis based on the criteria placed by the World Glaucoma Association. Combined nasal goniotomy and temporal trabeculotomy were done on each eye in an attempt to perform almost 360 degrees circumferential angle surgery without disturbing the superior 180 degrees of conjunctiva to preserve it for future filtering glaucoma surgeries. Results By first month, average IOP was 10.5 ± 4.3 mmHg with a 65.3% reduction from average pre-operative IOP. Almost the same percentage of reduction was maintained at 3rd,6th and 12th months postoperative visits with average IOP of 11.9 ± 4.65, 11.8 ± 2.77 and 13 ± 2.82 mmHg (60.7%, 61.1% and 57.2% reduction from pre-operative average). According to success rates, complete success has been achieved in all eyes but one (93.3%), with minor complications in 4 out of 15 eyes (26.6%) that did not affect IOP outcome. Nine out of fifteen eyes completed 18 months post-operative follow-up visits with a successfully, maintained target average IOP of 13.3 ± 3.0 mmHg (57.2% reduction). All of the mean IOP readings during post-operative follow-up period were significantly lower when compared to pre-operative IOP (p &lt; 0.0001). Only one eye had persistently elevated IOP of 26 mmHg at 1st and 3rd months post-operatively that necessitated a subsequent subscleral trabeculectomy which succeeded in controlling the pressure bringing it down to 15 mmHg on topical medications. Conclusion Nasal goniotomy – temporal trabeculotomy (NGTT) is the combination of two well established surgeries that exploits the advantages of circumferential angle surgery while sparing the superior conjunctiva completely for future surgeries if needed. This new procedure was safe and effective in lowering IOP by an average of 60% from pre-operative IOP with a sustained effect till 18 months post-operatively. We believe that this surgery might be added to the armentarium of the surgical management of infantile glaucomas with other circumferential angle surgeries.</description><identifier>ISSN: 1120-6721</identifier><identifier>EISSN: 1724-6016</identifier><identifier>DOI: 10.1177/11206721221085395</identifier><identifier>PMID: 35253454</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><ispartof>European journal of ophthalmology, 2022-11, Vol.32 (6), p.3470-3475</ispartof><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c340t-8f2eb81c9341ba35b9b4ff1157a200977f0b456cc1a15386041ee2417e8ec4883</citedby><cites>FETCH-LOGICAL-c340t-8f2eb81c9341ba35b9b4ff1157a200977f0b456cc1a15386041ee2417e8ec4883</cites><orcidid>0000-0003-3346-8067</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/11206721221085395$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/11206721221085395$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35253454$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abdelrahman, Ahmed Mostafa</creatorcontrib><creatorcontrib>Amin, Rana Hussein</creatorcontrib><title>Combined nasal goniotomy – temporal trabeculotomy (NGTT) for circumferential angle surgery in primary congenital glaucoma</title><title>European journal of ophthalmology</title><addtitle>European Journal of Ophthalmology</addtitle><description>Purpose To assess the safety and efficacy of combining nasal goniotomy with temporal trabeculotomy in the management of primary congenital glaucoma. Design Case series Methods Fifteen eyes of eleven children (3–12 months old at presentation) were enrolled in this study after the establishment of PCG diagnosis based on the criteria placed by the World Glaucoma Association. Combined nasal goniotomy and temporal trabeculotomy were done on each eye in an attempt to perform almost 360 degrees circumferential angle surgery without disturbing the superior 180 degrees of conjunctiva to preserve it for future filtering glaucoma surgeries. Results By first month, average IOP was 10.5 ± 4.3 mmHg with a 65.3% reduction from average pre-operative IOP. Almost the same percentage of reduction was maintained at 3rd,6th and 12th months postoperative visits with average IOP of 11.9 ± 4.65, 11.8 ± 2.77 and 13 ± 2.82 mmHg (60.7%, 61.1% and 57.2% reduction from pre-operative average). According to success rates, complete success has been achieved in all eyes but one (93.3%), with minor complications in 4 out of 15 eyes (26.6%) that did not affect IOP outcome. Nine out of fifteen eyes completed 18 months post-operative follow-up visits with a successfully, maintained target average IOP of 13.3 ± 3.0 mmHg (57.2% reduction). All of the mean IOP readings during post-operative follow-up period were significantly lower when compared to pre-operative IOP (p &lt; 0.0001). Only one eye had persistently elevated IOP of 26 mmHg at 1st and 3rd months post-operatively that necessitated a subsequent subscleral trabeculectomy which succeeded in controlling the pressure bringing it down to 15 mmHg on topical medications. Conclusion Nasal goniotomy – temporal trabeculotomy (NGTT) is the combination of two well established surgeries that exploits the advantages of circumferential angle surgery while sparing the superior conjunctiva completely for future surgeries if needed. This new procedure was safe and effective in lowering IOP by an average of 60% from pre-operative IOP with a sustained effect till 18 months post-operatively. We believe that this surgery might be added to the armentarium of the surgical management of infantile glaucomas with other circumferential angle surgeries.</description><issn>1120-6721</issn><issn>1724-6016</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9UMtOwzAQtBCIQuEDuCAf4ZDidew8jqiCglTBpZwjx11HqRK7spNDxYV_4A_5ElKlcEHitKOdmX0MIVfAZgBpegfAWZJy4BxYJuNcHpEzSLmIEgbJ8YAHPtoLJuQ8hA1jnOWCn5JJLLmMhRRn5H3u2rK2uKZWBdXQytnada7d0a-PT9phu3V-aHdelaj7ZqRuXhar1S01zlNde923Bj3arh6EylYN0tD7Cv2O1pZufd2qAWpnK7R1t9_RqF67Vl2QE6OagJeHOiVvjw-r-VO0fF08z--XkY4F66LMcCwz0HksoFSxLPNSGAMgU8UZy9PUsFLIRGtQIOMsYQIQuYAUM9Qiy-IpgXGu9i4Ej6Y4HFUAK_ZBFn-CHDzXo2fbly2ufx0_yQ2C2SgIqsJi43pvhx_-mfgNhVd9YA</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>Abdelrahman, Ahmed Mostafa</creator><creator>Amin, Rana Hussein</creator><general>SAGE Publications</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><orcidid>https://orcid.org/0000-0003-3346-8067</orcidid></search><sort><creationdate>20221101</creationdate><title>Combined nasal goniotomy – temporal trabeculotomy (NGTT) for circumferential angle surgery in primary congenital glaucoma</title><author>Abdelrahman, Ahmed Mostafa ; Amin, Rana Hussein</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c340t-8f2eb81c9341ba35b9b4ff1157a200977f0b456cc1a15386041ee2417e8ec4883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abdelrahman, Ahmed Mostafa</creatorcontrib><creatorcontrib>Amin, Rana Hussein</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><jtitle>European journal of ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abdelrahman, Ahmed Mostafa</au><au>Amin, Rana Hussein</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Combined nasal goniotomy – temporal trabeculotomy (NGTT) for circumferential angle surgery in primary congenital glaucoma</atitle><jtitle>European journal of ophthalmology</jtitle><addtitle>European Journal of Ophthalmology</addtitle><date>2022-11-01</date><risdate>2022</risdate><volume>32</volume><issue>6</issue><spage>3470</spage><epage>3475</epage><pages>3470-3475</pages><issn>1120-6721</issn><eissn>1724-6016</eissn><abstract>Purpose To assess the safety and efficacy of combining nasal goniotomy with temporal trabeculotomy in the management of primary congenital glaucoma. Design Case series Methods Fifteen eyes of eleven children (3–12 months old at presentation) were enrolled in this study after the establishment of PCG diagnosis based on the criteria placed by the World Glaucoma Association. Combined nasal goniotomy and temporal trabeculotomy were done on each eye in an attempt to perform almost 360 degrees circumferential angle surgery without disturbing the superior 180 degrees of conjunctiva to preserve it for future filtering glaucoma surgeries. Results By first month, average IOP was 10.5 ± 4.3 mmHg with a 65.3% reduction from average pre-operative IOP. Almost the same percentage of reduction was maintained at 3rd,6th and 12th months postoperative visits with average IOP of 11.9 ± 4.65, 11.8 ± 2.77 and 13 ± 2.82 mmHg (60.7%, 61.1% and 57.2% reduction from pre-operative average). According to success rates, complete success has been achieved in all eyes but one (93.3%), with minor complications in 4 out of 15 eyes (26.6%) that did not affect IOP outcome. Nine out of fifteen eyes completed 18 months post-operative follow-up visits with a successfully, maintained target average IOP of 13.3 ± 3.0 mmHg (57.2% reduction). All of the mean IOP readings during post-operative follow-up period were significantly lower when compared to pre-operative IOP (p &lt; 0.0001). Only one eye had persistently elevated IOP of 26 mmHg at 1st and 3rd months post-operatively that necessitated a subsequent subscleral trabeculectomy which succeeded in controlling the pressure bringing it down to 15 mmHg on topical medications. Conclusion Nasal goniotomy – temporal trabeculotomy (NGTT) is the combination of two well established surgeries that exploits the advantages of circumferential angle surgery while sparing the superior conjunctiva completely for future surgeries if needed. This new procedure was safe and effective in lowering IOP by an average of 60% from pre-operative IOP with a sustained effect till 18 months post-operatively. We believe that this surgery might be added to the armentarium of the surgical management of infantile glaucomas with other circumferential angle surgeries.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>35253454</pmid><doi>10.1177/11206721221085395</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-3346-8067</orcidid></addata></record>
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title Combined nasal goniotomy – temporal trabeculotomy (NGTT) for circumferential angle surgery in primary congenital glaucoma
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