Comparison of 360-Degree Trabeculotomy versus Traditional Angle Surgery in Primary Congenital Glaucoma

Précis: Systematic meta-analysis demonstrates greater IOP reduction, fewer glaucoma medication use and higher surgical success rate with 360-degree trabeculotomy compared to traditional angle surgery in primary congenital glaucoma. Purpose: Primary congenital glaucoma (PCG) is a rare vision threatening disorder, which can lead to blindness if untreated. The aim of the study is to compare the effectiveness of traditional angle surgery (goniotomy and rigid probe trabeculotomy) versus 360° trabeculotomy in children with PCG. Methods: A comprehensive search was conducted across PubMed, EMBASE, Scopus, Cochrane (CENTRAL), Science Direct and Clinicaltrials.gov. A total of 1740 studies were obtained from databases, and 12 studies, 3 RCTs and 9 Retrospective studies met the inclusion criteria. Mean Differences (MD) for continuous outcomes and Odds Ratios (OR) for dichotomous outcomes were analyzed. The primary outcomes were the reduction in intraocular pressure (IOP) and numbers of anti-glaucoma medications at 12 months postoperatively. Results: Pooled analysis of 778 eyes demonstrated that 360° trabeculotomy showed significant reduction in IOP and number of anti-glaucoma medications compared to traditional angle surgery by -2.10 mmHg (-3.26,-0.94; P =0.0004, I²=55%) and -0.47 drops (-0.69, -0.25; P <0.0001, I²=55%), respectively. Compared to traditional angle surgery group, the 360° trabeculotomy group showed higher complete and qualified success rates with OR of 5.07 (3.43-7.50; P <0.0001, I²=4%) and 3.00 (1.47-6.12; P =0.003, I²=46%) respectively, and as well as, reduction in failure rate with OR of 0.18 (0.11-0.31; P <0.0001, I²=14%). No statistically significant differences were observed for post-operative axial length, change in cup/disc ratio, change in horizontal corneal diameter. Conclusions: 360° trabeculotomy showed greater reduction in IOP and number of anti-glaucoma medications postoperatively than traditional angle surgery with improved success and reduced failure rates.