surgery for congenital glaucoma

1. Trabeculotomy

2. • Recommended originally as surgical treatment
for both primary infantile glaucoma and
primary open-angle glaucoma.

3. Indication
Primary infantile glaucoma
• when angle structures cannot be visualized
through a cloudy cornea.
• After the failure of two goniotomies.
Juvenile open-angle glaucoma

4. • Long-term results are impressive in managing
infantile glaucoma and open-angle glaucoma
in younger adults.
• Trabeculotomy has a high success rate (80–
90%).
• less useful in older patients with chronic
open-angle glaucoma unless there are angle
changes compatible with juvenile anomalies.

5. procedure

6. • High magnification
• Depper scleral dissection.

7. • canal is found in the corneoscleral sulcus
at the blue-grey/white transition
between scleral and corneal tissue.
• Using high magnification (16x to 25x),
• cellulose sponge can dry the junction and
allow for the appreciation of droplets of
clear aqueous beading precisely above
the canal.
• A radial incision 2 mm in length is made
at that point.
• As the canal is approached, there is a
seeping of aqueous and often a tinge of
blood as the outer wall of the canal is cut

8. To ensure the accuracy of the incision
 3 cm of 5-0 or 6-0 monofilament (e.g., Prolene or
nylon) suture with a beveled tip.
 Entered 5 mm.
 suture should enter easily and slide into the eye
following the course of the canal.
 not be possible to rotate the suture anteriorly into
either the anterior chamber or posteriorly into the
suprachoroidal space.
 The suture may be viewed gonioscopically to be sure
of its proper positioning.

10. ICath
• catheter with an LED on the end which allows
visualization of the catheter as it transits the
360° of Schlemm’ canal.

11. Harms or McPherson trabeculotome
• Probe centripetely
rotated.
• Parallel to iris plane.
• If more ANT – desment
tear.
• If more POST- lens
demage.

13. Purse-string 360° trabeculotomy
• reported to have an excellent ‘success’ rate for pressure
control comparable to or better than goniotomy and
trabeculotomy with metal trabeculotomes.
• One complication of this procedure is that the Prolene
suture or the catheter can be misdirected into either
the anterior chamber or, more ominously, into the
suprachoroidal space.
• can also be done with the Icath.

14. Combined trabeculotomy and
trabeculectomy
• long-term outcome of mitomycin-C
trabeculectomies was similar to that of
Ahmed valve implants.
• complications were greater for the
trabeculectomy group,
• whereas the Ahmed group was morelikely to
need subsequent medications to control the
pressure.

15. Trabeculodialysis
Glaucoma secondary to juvenile
rheumatoid arthritis (Still’s disease)

16. Thnak
you