PRIMARBUPHTHALMUS (KINDLICHES GLAUKOM): BEHANDELT DURCH TRABEKULOTOMIE AB EXTERNO

The results are reported of a prospective study of 21 children (29 eyes) with congenital, infantile and juvenile glaucoma treated by trabeculotomy ab externo as well as a retrospective study of 5 eyes treated by trabeculotomy after multiple goniotomies had failed to control the intraocular pressure. The operation is safe with only minor surgical complications and highly successful (39 of 43 eyes). The operation failed in 4 eyes (10%). In these eyes the disease was of congenital onset and in 3 eyes fibrous cicatricial membrane occluding the angle was noted preoperatively. At operation, in 2 eyes the canal of Schlemm was inserted anteriorly (0.5 mm from the limbus), presumably a result of the cicatricial process. These are probably cases of secondary glaucoma following some intrauterine inflammatory process. Preoperative intraocular pressure and severity of the disease did not influence the results of operation. The postoperative appearance of the angle after trabeculotomy ab externo is similar to that seen after goniotomy (apart from the strength rupture of the inner wall of Schlemm's canal seen after trabeculotomy). It is concluded that a successful result in both operations is achieved by removing the obstruction caused by a mesodermal anomaly in the angle. The advantages of the trabeculotomy operation over goniotomy are discussed.