Outcomes of Goniotomy in Primary Congenital Glaucoma

To report the outcomes of goniotomy in young children with primary congenital glaucoma. This retrospective study included 26 eyes of 19 patients with primary congenital glaucoma who underwent goniotomy as the initial procedure. All patients were aged less than 3 years and had no history of previous ocular surgery. The main outcome measures were intraocular pressure (IOP), cup/disc (C/D) ratio, corneal diameter, success rate and complications. Surgical success was defined as IOP less than 20 mmHg (with or without medications) without progression of disc cupping or increase in corneal diameter. Mean age at the time of diagnosis was 10.5±12.2 (range 0-36, median 7.5) months. Mean follow-up period was 19.3±18.3 (range 2-62, median 12) months. Preoperatively, 20 eyes (76.9 %) had corneal edema. Mean corneal diameter was 13.60±0.99 mm (range 12-16 mm) preoperatively which reached 13.98±1.08 mm (range 12-16 mm) at last follow-up (P=0.174). Mean IOP was 27.74±6.07 (range 17-44) mmHg pre-operatively which decreased to 24.44±7.88 (range 11-40) mmHg at final follow-up (P=0.048). Surgical success after the first goniotomy was 34.6%. The age of onset, level of IOP, C/D ratio, corneal clarity and corneal diameter did not significantly affect the surgical outcome. There was small hyphema in all patients postoperatively, which resolved rapidly in all except one who required surgical evacuation. Goniotomy is a safe and relatively effective procedure in young children with primary congenital glaucoma, but the success rate was low in our study; which can be attributed to the greater severity of the disease.