Goniotomy arc size in juvenile open-angle glaucoma: 240 degrees performed like 360 with less hyphaema

Design

Prospective, comparative, non-randomised multicentre study, 19 Chinese institutions

Population

98 patients (126 eyes) with juvenile open-angle glaucoma, mean age 22.9 years

Primary outcome

Surgical success (intraocular pressure 21 mmHg or lower) at 12 months by goniotomy arc

Effect

Complete success 13.3% (120), 55.3% (240), 64.7% (360); hyphaema 31.1%, 34.0%, 64.7%

A prospective comparative study enrolled 98 patients (126 eyes) with juvenile open-angle glaucoma from 19 Chinese institutions. Eyes had goniotomy with a 120, 240 or 360 degree arc. Success was an intraocular pressure of 21 mmHg or lower, complete without medication or qualified with it. Mean age was 22.9 years.

At 12 months complete success was 55.3% with 240 degrees and 64.7% with 360 degrees (P = 0.447), both better than 13.3% with 120 degrees. Qualified success was 80.0%, 93.6% and 91.2% respectively, with no significant difference. The 360 degree group needed fewer medications at six months but not at twelve. Hyphaema was commonest with 360 degrees (64.7%) versus 34.0% with 240 and 31.1% with 120 (P = 0.003).

The groups were not randomised, so surgeon preference and disease severity may differ between arcs. The authors say validation in randomised studies is needed.

• Complete success at 12 months was 55.3% (240 degrees), 64.7% (360) and 13.3% (120).
• 240 and 360 degrees did not differ significantly.
• Hyphaema occurred in 64.7% with 360 degrees versus 34.0% with 240.
• Non-randomised allocation limits comparison.
• A 120 degree arc looks inadequate for this population on current data.

Why it matters

It informs a technique choice that otherwise relies on habit in a young population who need years of pressure control.

Don't overread it

Non-randomised groups and a 12-month horizon limit conclusions about long-term pressure control and safety.

The statistics, in plain English

Complete success of 55% versus 65% was not statistically different with these numbers, but the groups were small, so a real gap of ten points could be missed. Hyphaema differences of 64.7% versus 34.0% were significant.

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