Indian Journal of Ophthalmology

ORIGINAL ARTICLE
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

Correspondence Address:
K Vengala Rao
Department of Ophthalmology, Guntur Medical College, Guntur
India




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


Full Text

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.

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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.

Operative Complications

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.

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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.

 DISCUSSION



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.

 SUMMARY



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.[4]

References

1Murthy K.R., 1979. Ind. J. Ophthalmol. 27:158.
2Watson P.G.. 1969. Trans. Ophthalmol_ Soc. U.K. 89: 523.
3Scheie HG., 1963. Arch. Ophthalmol. 69: 13.
4Kwitko M.L., 1979. Surgery of the Infant eye Appleton-Century Crofts/New York.