Year : 1984 | Volume
: 32 | Issue : 5 | Page : 439--440
Trabeculectomy in congenital glaucoma
K Vengala Rao, C Madhava Sai, BV Nagendra Babu
Department of Ophthalmology, Guntur Medical College Guntur, India
K Vengala Rao
Department of Ophthalmology, Guntur Medical College, Guntur
|How to cite this article:|
Rao K V, Sai C M, Nagendra Babu B V. Trabeculectomy in congenital glaucoma.Indian J Ophthalmol 1984;32:439-440
|How to cite this URL:|
Rao K V, Sai C M, Nagendra Babu B V. Trabeculectomy in congenital glaucoma. Indian J Ophthalmol [serial online] 1984 [cited 2021 Sep 21 ];32:439-440
Available from: https://www.ijo.in/text.asp?1984/32/5/439/27535
Congenital glaucoma is reported to be rare and an ophthalmologist is unlikely to see more than one new infantile glaucoma in five years of practice. The disease is not rare in Andhra Pradesh probably because of the frequency of consanguinous marriages.
During the period of 4 years (1979-83) 18 children with congenital glaucoma were treated in the Department of Ophthalmology, Guntur Medical College, Guntur. 25 eyes of these 18 children were subjected to Trabeculectomy. Consanguinity was present in families.
MATERIAL AND METHODS
Diagnosis of congenital glaucoma was made by history, measurement of corneal diameter, slit lamp examination, gonioscopy where possible, fundus examination and measurement of intra-ocular pressure under anaesthesia. General examination was made to exclude other congenital anomalies.
The children were kept on oral acetazolamide pre-operatively for 2 to 3 days. If the tension was more than 30mm. I.V. Mannitol was given.
Watson's procedure of trabeculectomy was performed in all the cases. Scleral flap was sutured with 2 to 4, 8° silk sutures. The cases were followed from 1 to 4 years. the youngest child that was operated was one month old and the oldest was of 15 years.
Corneal oedema was present in all cases. Reptures of Descemet's membrane was present in 15 eyes. Corneal diameter was 12-14 mm in 15 eyes and was greater than 14 mm in 10 eyes.
Intraocular tension was 20-25 mm/Hg in 5 eyes.
1. Vitreous prolapse occured in one eye as a result of subluxation of lens.
2. Button holing of scleral flap occured in 2 eyes which was repaired.
3. Bulging of the peripheral iris occured in 3 cases which subsided after doing peripheral iridectomy.
Post Operative Complications
1. Shallow anterior chamber was seen in 4 eyes but the anterior chamber formed by 7th day in all cases. This was probably due to excessive drainage during first few days in the post-operative period.
2. Uveitis was seen in one eye which was con
trolled by Atropine and steroids.
3. Hyphema was seen in 3 cases which com
pletely cleared by 10th day.
Corneal transparency: Cornea regained its normal transparency in 15 eyes and in the remaining 10 eyes even though cornea cleared to a great extent, permanent opacities were left behind.
Vision: It was not possible to record vision in most of the children but guided by the fixation and following movements and other reflexes there was definite improvement of vision in 12 patients.
It is generally acknowledged that surgery is the treatment of choice in congenital glaucoma, and the operation of choice is goniotomy. It is not -- uncommon to find an I.O.P. of 20 to 30 MM. of Hg in normal infants and such a pressure is not in itself an indication for surgery. There must be other signs of glaucoma like corneal oedema, corneal enlargement, tears of Descemet's membrane or glaucomatous cupping.
Goniotomy is credited with a success rate of 77%, Goniopuncture 64 to 68%, Schie's operation 54%, and iridencleisis 35%.
As sophisticated equipment is necessary with expertise in performing goniotomy, this procedure is not being practical in many institutions.
With good experience in doing Trabeculectomythis operation was tried in the present series of congenital glaucoma with rewarding results in terms of tension control and the corneal transparency.
The tension was controlled in 20 out of 25 cases and cornea cleared well in 15 eyes. This shows that in 75% of cases the operation of trabeculectomy was successful which compares favourably with goniotomy. Reoperation was doen in 2 cases and in 3 cases tension was under control with medical treatment.
Trabeculectomy in congenital glaucoma is more difficult to perform than in adults because of the following reasons.
1. Definition of surgical limbus is more difficult.
2. Fashioning the scleral flap is more difficult
as the sclera is thin.
Post operative shallow anterior chamber is more common in congenital glaucoma (4 in 25) which is rare in adults. Preoperative hypotensive measures are very important.
Diffuse blebs were found in 15 eyes indicating drainage into sub-conjunctival space. In the remaining cases where the tension was normal, the drainage may be occuring through the cut ends of Schlem's canal.
Trabeculectomy was performed in 25 eyes with congenital glaucoma with a success rate of 75% which compares very favourably with goniotomy. Incidence of shallow anterior chamber post-operatively was 16%. Preoperative hypotensive measures including I.V. Mannitol enhances the success rate.
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|3||Scheie HG., 1963. Arch. Ophthalmol. 69: 13.|
|4||Kwitko M.L., 1979. Surgery of the Infant eye Appleton-Century Crofts/New York.|