Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy in Children with Early-Onset Glaucoma Secondary To Sturge-Weber Syndrome

Abstract

Purpose: To evaluate the effectiveness and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in managing early-onset glaucoma secondary to Sturge-Weber syndrome (SWS). Design: A retrospective interventional case series. Participants: Medical records of 16 patients (22 eyes) diagnosed with early-onset glaucoma secondary to SWS who underwent GATT surgery were reviewed. Methods: All patients underwent GATT surgery using a 5-0 or 6-0 prolene suture under general anesthesia. Main Outcome Measures: The primary outcomes were intraocular pressure (IOP) reduction, complete surgical success (IOP <= 18 mmHg without medications), qualified surgical success (IOP <= 18 mmHg with medications), and postoperative complications. Results: The mean IOP decreased significantly from 25.4 +/- 4.8 mmHg at baseline to 15.7 +/- 4.2 mmHg at the final follow-up (P < 0.001), representing a 38.19% reduction. The mean age at the time of GATT surgery was 33.6 +/- 33.9 months. The mean follow-up duration was 16.3 +/- 6.4 months. Complete surgical success was achieved in 45.4% of eyes (10 out of 22), while qualified success was reached in 81.8% of eyes (18 out of 22). Despite the overall success, 18.1% of eyes (4 eyes) required additional surgical interventions during the follow-up period. These included Ahmed glaucoma valve implantation in 1 eye, trabeculectomy in 2 eyes, and transscleral diode laser cyclophotocoagulation in 1 eye. Transient hyphema was the only reported complication, resolving spontaneously within 1 week without further intervention. Conclusions: Gonioscopy-assisted transluminal trabeculotomy appears to be a promising surgical option for managing early-onset glaucoma in patients with SWS, offering significant IOP reduction and a favorable safety profile within the limitations of our study. However, further studies with longer follow-up periods and comparative groups are necessary to confirm these findings.