Indian Journal of Ophthalmology

ARTICLE
Year
: 1983  |  Volume : 31  |  Issue : 5  |  Page : 609--611

Evaluation of surgery for congenital glaucoma


NN Sood, HC Aggarwal, BR Kalra 
 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., Ansari Nagar, New Delhi, India

Correspondence Address:
N N Sood
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., Ansari Nagar, New Delhi
India




How to cite this article:
Sood N N, Aggarwal H C, Kalra B R. Evaluation of surgery for congenital glaucoma.Indian J Ophthalmol 1983;31:609-611


How to cite this URL:
Sood N N, Aggarwal H C, Kalra B R. Evaluation of surgery for congenital glaucoma. Indian J Ophthalmol [serial online] 1983 [cited 2019 Sep 23 ];31:609-611
Available from: http://www.ijo.in/text.asp?1983/31/5/609/36604


Full Text

Surgical management of congenital glaucoma is tending to pass to certain specialized centres, goniotomy under the contact lens visualization has been reported as the safest and most effective treatment [2],[3] . Over the European continent, however, trabeculo­tomy is considered as the procedure of choice. No results about the efficiency of these procedures is available from this country.

In an earlier communication we had highlighted the problems of early onset of the disease entity and later presentations- of these cases. Such cases, therefore, come at the stage when the corneal diameters were increased and advanced corneal changes had set in, precluding procedures like goniotomy & goniopuncture [Table 1]. In such cases the operation of trabeculotomy ab externo with trabeculectomy was tried.

 Materials and Methods



A total of 105 eyes of sixty four cases of congenital glaucoma with bilateral involvement in 41 cases, right eye in twelve cases, left eye in eleven cases, have been included in this study. In 83 eyes (79.6%) corneal opacity of varying extent and different grades was present. The intraocular pressure varied from 23-60 mm. Hg. The horizontal corneal diameter in these cases was over 13 mm. in 55 eyes (50%).

 Observations



The results of various surgical procedures carried out in our cases is given in [Table 2]. In 16 eyes a repeat surgery had to be done to control the intraocular pressure. [Table 3].

 Discussion



The conventional operative procedures described for congenital glaucoma were goniotomy, goniopuncture, goniotomy combin­ed with goniopuncture. These procedures can be carried in cases with clear cornea to allow visualisation of angle structures at the time of operation. Further these procedures are preferable in cases having maximal corneal diameter upto 14 mms. 2 (Kwitko 1973). Moreover, at times procedures are required to be repeated.

This study highlights that in majority of our cases (79.6%) a varying degree of corneal opacity was present by the time the cases reached the hospitals, making clear visualisation of the anterior chamber angle structures impossible at the time of operation.

During the period of 1974 to 1977 we tried goniotomy in two eyes without any successful result. Goniopuncture was attempted only in one case with successful results. These procedures could be tried among the few cases who had clear cornea. During this period, in twenty seven eyes where the corneal opacity was present, an alternative procedures of free filtering surgery such as Scheie's operation, anterior sclerectomy and iridencleisis were attempted. Although in majority of cases we were able to achieve a hyotonic eye during immediate post operative period but with the passage of time the tension started building up during post operative follow up. The final success could be no better than 55.5-. This lead us to try some other procedure which could give us better results in these cases.

During 1977-79 trabeculectomy was tried in these cases of congenital glaucoma with some modifications-like larger resection of deeper flap. & cauterization of the triangular edge of superficial scleral flap. A total of 52 eyes having congenital glaucoma with corneal opacity were operated by the surgical technique of trabeculectomy. The results of this operation were slightly better with intraocular pressure control in 63.4-- eyes (as compared to 55.5­with free filtering surgery) with fewer complica­tions such as post operative shallow chamber, post operative uveitis and immediate post operative hypotony. Although the I.O.P. was controlled in all cases in the immediate post operative period yet in longer follow up the effective control was there in only 33 eyes.

During 1979-1981 being not very much satisfied with the previous success rate of free filtering surgery and trabeculectomy we decided to operate our cases of congenital glaucoma by a newer technique of trabeculotomy [1] (Harm and Danheim 1970) combined with trabeculec. tomy. A total of nineteen eyes were operated by this technique (details to be shown during presentation). In seventeen eyes (89.5%) the intraocular pressure remains controlled. In the period of follow up varies from six months to two years. There were no serious operative or post operative complications except small degree of hyphaema which absorbed spontaneously with passage, of time.

 Summary



In the management of congenital glaucoma the choice and success of the operative procedure depends on the duration of raised intraocular pressure, presence of corneal opacity and enlarged corneal diameter. The procedure of trabeculotomy "ab externo" cum trabeculec­tomy is the safest and most effective in achieving control of intraocular pressure in our cases of congenital glaucoma associated with corneal opacity. This procedure can be tried in cases with clear cornea also. Since this type of cases are few, surgery requires expertise and operating microscope therefore such operation facilities should be developed at least in few developed centres in India.

References

1Harm, H. & Danheim, R., Adv. Ophthalmol., 22:121,1970.
2Kwitko, M.L., "Glaucoma in infants and childern" 1st Edition p. 500 Appleton-Century­Croffs, New York, 1973.
3Shaffer, R.N. & Weiss, D.T., "Congenital and Paediatric glaucoma" 1st edition p. 181, The C.V. Mosby Company, Saint Louis, 1970.