Sightsavers Logo
Research centre
  • Home
  • About us
  • Research approach
  • Research studies and publications
  • Evidence gap maps
Join in:
  • Join in: Facebook
  • Join in: Twitter
  • Join in: Instagram
  • Join in: LinkedIn
  • Join in: YouTube
  • Global
  • Close search bar
    Donate
    • Home
    • About us
    • Research approach
    • Research studies and publications
    • Evidence gap maps

    Surgical interventions for primary congenital glaucoma

    Methodological quality of the review: High confidence

     

    Authors: Ghate D, Wang X.

     

    Region: USA, Egypt, Israel, Lebanon and Saudi Arabia

     

    Sector: Glaucoma

     

    Sub-sector: Sugery

    Equity focus: Children aged 1 or less

    Review type: Other review

    Quantitative synthesis method: Narrative synthesis

    Qualitative synthesis method: Not applicable

    Background:

    Primary congenital glaucoma (PCG) manifests within the first few years of a child’s life and is not associated with any other systemic or ocular abnormalities. PCG results in considerable morbidity even in developed countries. Several surgical techniques for treating this condition, and lowering the intraocular pressure (IOP) associated with it, have been described.

    Objectives:

    To compare the effectiveness and safety of different surgical techniques for PCG.

    Main findings:

    The authors included a total of six trials (four randomized and two quasi-randomized) with 102 eyes in 61 children. Two trials were conducted in the USA and one trial each in Egypt, Israel, Lebanon and Saudi Arabia. All trials included children aged younger than one year when diagnosed with PCG, and followed them for periods ranging from six months to five years. No two trials compared the same pair of surgical interventions, so the authors did not perform any meta-analysis.

    One trial compared trabeculotomy versus goniotomy; a second trial compared combined trabeculectomy-trabeculotomy with mitomycin C versus trabeculectomy-trabeculotomy with mitomycin C and deep sclerectomy; a third trial compared combined trabeculotomy-trabeculectomy versus trabeculotomy; a fourth trial compared one goniotomy versus two goniotomies; a fifth trial compared trabeculotomy versus viscocanalostomy; and the sixth trial compared surgical goniotomy versus neodymium-YAG laser goniotomy.

    For IOP change and surgical success (defined by IOP achieved), none of the trials reported a difference between pairs of surgical techniques. However, the authors note that due to the limited sample sizes for all trials (average of 10 children per trial), the evidence as to whether a particular surgical technique is effective and which surgical technique is better still remains uncertain. Adverse events, such as choroidal detachment, shallow anterior chamber and hyphema, were reported from four trials. The authors found that none of the trials reported quality of life or economic data. These trials were neither designed nor reported well overall. Two trials were quasi-randomized trials and judged to have high risk of selection bias; four trials were at unclear or high risk for performance bias and detection bias; and we judged one trial to have high risk of attrition bias due to high proportions of losses to follow-up.

    Reviewers stated that due to poor study design and reporting, the reliability and applicability of evidence remain unclear.

    Methodology: 

    The authors searched CENTRAL, Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, EMBASE, PubMed, the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, from inception to 2014. No date or language restrictions were applied in the electronic searches for trials. In addition, the authors reviewed references lists of the trials included in the review.

    Inclusion criteria consisted of randomized and quasi-randomized trials in which different types of surgical interventions were compared in children under five years of age with PCG. Primary outcome measure for comparison of interventions was IOP at one year after surgery.

    Two reviewers independently reviewed studies for inclusion, extracted data of included studies and assessed risk of bias in included studies.

    The authors conducted a narrative synthesis of included studies.

    Applicability/external validity:

    Reviewers stated that due to poor study design and reporting, the reliability and applicability of evidence remain unclear.

    Geographic focus

    Included studies were conducted in the USA, Egypt, Israel, Lebanon and Saudi Arabia. However, the authors reported that due to poor quality of included studies it is not possible to discuss applicability of findings to other settings.

    Summary of quality assessment:

    Overall, there is high confidence in the review as one minor limitation was identified. Authors did not contact experts/authors for further relevant studies.

    Publication Source:

    Ghate D, Wang X (2015) Surgical interventions for primary congenital glaucoma. Cochrane Database Syst Rev. 2015 Jan 30;1:CD008213.

    source

    Sightsavers Logo
    Research centre
    • Join in:
    • Join in: Facebook
    • Join in: X
    • Join in: Instagram
    • Join in: LinkedIn
    • Join in: YouTube

    Protecting sight, fighting disease and promoting equality for all

  • Accessibility
  • Sightsavers homepage
  • Our policies
  • Media centre
  • Contact us
  • Jobs
  • Cookies and privacy Terms and conditions Modern slavery statement Safeguarding

    © 2025 by Sightsavers, Inc., Business Address for all correspondence: One Boston Place, Suite 2600, Boston, MA 02108.

    Our website uses cookies

    To make sure you have a great experience on our site, we’d like your consent to use cookies. These will collect anonymous statistics to personalise your experience.

    Manage preferences

    You have the option to enable non-essential cookies, which will help us enhance your experience and improve our website.

    Essential cookiesAlways on

    These enable our site to work correctly, for example by storing page settings. You can disable these by changing your browser settings, but some parts of our website will not work as expected.

    Analytics cookies

    To improve our website, we’d like to collect anonymous data about how you use the site, such as which pages you read, the device you’re using, and whether your visit includes a donation. This is completely anonymous, and is never used to profile individual visitors.

    Advertising cookies

    To raise awareness about our work, we’d like to show you Sightsavers adverts as you browse the web. By accepting these cookies, our advertising partners may use anonymous information to show you our adverts on other websites you visit. If you do not enable advertising cookies, you will still see adverts on other websites, but they may be less relevant to you. For info, see the Google Ads privacy policy.