Influence of goniotomy incisional arc size on its efficacy and safety in juvenile open-angle glaucoma: a prospective multicentre study

PURPOSE: To evaluate the effect of goniotomy (GT) arc size on efficacy and safety in juvenile open-angle glaucoma (JOAG). METHODS: This prospective, comparative, multicentre study enrolled 98 patients (126 eyes) with JOAG from 19 Chinese institutions. Patients who underwent GT were categorised into three groups based on the arc size of the incision: (1) 120° GT, (2) 240° GT and (3) 360° GT. Outcomes included intraocular pressure (IOP), surgical success rates, medication use and complications. Success was defined as postoperative IOP ≤21 mm Hg without (complete) or with (qualified) medications. RESULTS: Mean patient age was 22.9±8.7 years. At 12 months postoperatively, complete success rates were comparable between the 240° GT (55.3%) and the 360° GT (64.7%) (p=0.447), and both were superior to the 120° GT (13.3%) (both p<0.001). Qualified success rates in the 120° GT, 240° GT and 360° GT groups were 80.0%, 93.6% and 91.2%, respectively, with no statistically significant difference (p=0.302). The 360° group required fewer medications than the other two groups at 6 months (both p<0.001), with no difference at 12 months (p=0.234). Hyphema was the most common complication, occurring more frequently in the 360° group (64.7%) than in the 240° (34.0%) and 120° (31.1%) groups (p=0.003). CONCLUSIONS: 240° GT and 360° GT demonstrated comparable efficacy, both superior to 120° GT. 240° GT showed similar observed efficacy to 360° GT, along with procedural simplicity, fewer complications and no consumable use for JOAG; these findings warrant validation in randomised studies.