Dual blade ab interno trabeculectomy versus goniotomy in primary congenital glaucoma

Introduction: Management of primary congenital glaucoma (PCG) is challenging. Kahook dual blade (KDB) removes a strip of the trabecular meshwork which could make it superior to simple goniotomy in treating the angle anomaly. This study compares KDB ab interno trabeculectomy to conventional goniotomy in PCG. Methods: A total of 42 eyes with PCG were randomized to undergo ab-interno trabeculectomy using the KDB or goniotomy using a 25-gauge irrigating needle, targeting 120°-140° of the nasal iridocorneal angle. Patients were seen at 1, 3, 6 and 12 months. Success was defined as IOP ≤21 mm Hg at final follow-up, with no evidence of glaucoma progression or need further surgery. Results: KDB group included 21 eyes, with a median age of 6 months; the goniotomy group included 21 eyes, with a median age of 5 months at time of surgery. There was a significant reduction in IOP in both groups at all follow-up visits. The reduction in number of glaucoma medications was significant at 1, 3, and 6 months postoperatively in the KDB group, and at 1 month in the goniotomy group.There was no significant difference in IOP or glaucoma medications between both groups at any follow-up visit. Success was achieved in 12 eyes (57.1%) in each group, with no eyes developing any serious complications. Conclusion/relevance: There was a significant reduction in IOP in both groups but no significant difference between both groups in IOP, glaucoma medications or success rates at final follow-up. One-year follow-up shows that KDB is at least as effective as goniotomy in the treatment of PCG.