|Year : 1979 | Volume
| Issue : 4 | Page : 158-159
Trabeculectomy in congenital glaucoma
Jayanagar, Bangalore, India
K R Murthy
Vijayanatha 186, 25th Cross, III Block, Jayanagar Bangalore
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Murthy K R. Trabeculectomy in congenital glaucoma. Indian J Ophthalmol 1979;27:158-9
During the last five years (1972-1977) twenty eyes of fifteen patients suffering from developmental glaucoma were subjected to the operative procedure of Trabeculectomy,
| Materials and Methods|| |
Of the fifteen cases of developmental glaucoma, ten were congenital (under the age of five years) and five children who were between the ages of five and fifteen years, were probably instances of juvenile glaucoma. While eleven patients were boys, five were girls.
The diagnosis was established by measuring the corneal diameter and the intraocular tension under general anaesthesia. The clarity of the cornea was noted and wherever possible the appearance of the optic, disc, and gonioscopic findings, of the angle of the anterior chamber were recorded.
The surgical technique of trabeculectomy employed, was according to the procedure described by Watson.
All the cases have been followed for a minimum period of six months and majority of them over two years.
Persistant shallow anterior chamber at the 1st and subsequent dressings was noted in four eyes. In three of them it resulted in the formation of peripheral anterior synechiae. One of these developed increase of the intraocular pressure several months after the surgery and required a subsequent trabeculectomy to normalise the tension.
Control of the intraocular Tension
In ten cases (50%) the intraocular tension was controlled by surgery alone. Of these in eight eyes one surgical procedure was employed and in two eyes repetition of the surgical procedure was necessary. In two eyes (10%) following one surgical procedure, with the addition of medical treatment the pressure remained with n normal limits.
In eight patents (40%) the tension remained uncontrolled. Subsequent surgery was refused - by the patients.
Difficulties during surgery
Definition of the surgical limbus was difficult, as the appearance of the limbus was seen to extend over a wide area. The side of the Schlemn's canal could not be ascertained with the microscope accurately.
Fashioning the scleral flap was difficult due to the thin sclera, When the horizontal incision parallel to the limbus was made 4 mm away, in some cases the aqueous escaped, although no entry into the anterior chamber was possible at this site, and the depth of the anterior chamber remained apparently unaltered.
During the excision of the trabecular tissue the bulge of the peripheral part of the iris caused inconvenience and required performance of the iridectomy before the excision of the trabecular tissue.
In two cases of congenital aniridia, vitreous presented at the section.
In one patient troublesome hyphema occured following the iridectomy. Reformation of the anterior chamber was difficult in five cases and the chamber remained shallow at the end of the surgery.
| Comments|| |
Goniotomy has been advocated as the treatment of choice for congenital glaucoma with a success rate of 77%. The other procedure which has been employed is goniopuncture with or without goniotomy with a success rate of 64%-68%. Conventional filtering procedures have been resorted when above procedures have failed. The success rate in peripheral iridectomy with posterior lip cautery and in iridencleisis has been reported to be 54% and 35% respectively.
In the present series in five eyes the gonioscopy was not possible due to extreme cloudiness of the cornea. In four others goniotomy was tried without success. Blind goniotomy as well as goniopuncture procedures were not attempted. The reason for not persisting with the operation of goniotomy was, that it was found to be technically difficult and the early success met with trabeculectomy was encouraging. In the final analysis it is found that in only 50% of the eyes the tension was controlled with trabeculectomy and in an additional 10% with the help of miotics. However the complications have been minimal and vitreous loss occurred only in two cases with congenital aniridia.
The early escape of the aqueous when the horizontal incision was made was probably due to inadvertent entry into the posterior chamber due to the thin sclera.
The significant difference was noted in the behaviour of the anterior chamber in the postoperative period when compared with the cases of chronic simple glaucoma treated by this operative procedure. While shallow anterior chamber was insignificant in the adult series, in cases of congenital glaucoma there was an increased incidence of shallow anterior chamber and it was 25% in the present series. This might be due to the abnormal placement of the iris lens diaphragm in these cases.
| Summary|| |
Twenty eyes of fifteen patients with developmental glaucoma were treated with the operative procedure of trabeculectomy. Difficulties during surgery are discussed. A success rate of 50% was observed by this technique. Incidence of shallow anterior chamber in the postoperative period was 25%.
| References|| |
Barkan, O., 1955, Trans. Amer. Acad. Ophthal & Otolaryng., 59, 309.
Hans, J., 1955, Trans. Amer. Acad. Ophthal & Otolarying., 59, 333.
Ridgway, A.EA., 1972,
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Scheie, H.G., 1963, Arch. Ophthal., 69, 13.
Scheie, HS., 1955, Trans. Amer. Acad. Ophthal. & Otolayyng., 59, 309.
Watson, P.G., 1969, Trans. Ophthal. Soc. U.K., 89, 523.