Primary Congenital Glaucoma (cont.)
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What Is the Treatment for Primary Congenital Glaucoma?
Primary congenital glaucoma is almost always treated surgically.
Medications in the form of eyedrops are used initially to lower the eye pressure prior to surgery. Other medications may also be used to help decrease the clouding of the cornea in preparation for surgery.
Surgery is performed to allow the aqueous fluid to more easily drain back into the bloodstream.
The most common surgical procedures for primary congenital glaucoma are goniotomy and trabeculotomy. In both procedures, the ophthalmologist makes an incision across the trabecular meshwork fibers that are impeding the aqueous flow. In goniotomy, the procedure is done by inserting an instrument into the eye and visualizing the angle directly with a gonioscopy lens. This can only be done if the cornea is clear. In a trabeculotomy, the trabecular meshwork is approached via an incision made on the outside wall of the eye; this is the preferred procedure if the cornea is too cloudy for a goniotomy.
Goniotomy and trabeculotomy have similar success rates of approximately 80%.
If medications and goniotomies and/or trabeculotomies fail to reduce eye pressure sufficiently, the remaining options are to perform a surgery that permits the aqueous to bypass the trabecular meshwork (trabeculectomy, or drainage implant surgery) or to reduce the production of aqueous (ciliary body ablation procedures). In a trabeculectomy, the surgeon creates a new drainage channel that allows the aqueous to drain directly from the inside of the eye to a small pocket of tissue (called a bleb) and then back into the bloodstream, thus lowering the eye pressure. Medications called antimetabolites are sometimes used in conjunction with trabeculectomy to reduce the odds of scarring of the bleb. In drainage implant surgery, aqueous is shunted back to the bloodstream via an implanted drainage device (for example, Molteno, Baerveldt, or Ahmed implants).
Ciliary body ablation procedures are usually reserved as a treatment of last resort.
In this procedure, the ophthalmologist uses a laser (Nd: YAG or diode laser) or a freezing probe (cryotherapy) to intentionally destroy a portion of the ciliary body, which is the organ in the eye that produces the aqueous. Eye pressure is thus lowered because less fluid builds up inside the eye.
Following any surgery, close follow-up is important as, with any surgical procedure, complications may occur. Serious complications may include blood collecting in the eye (hyphema), infection, damage to the lens, uveitis or internal swelling (inflammation), and eye pressure that is too low (hypotony).
Because children may also have complications from general anesthesia both eyes may be treated in the same operating room session (bilateral procedure).
Medically Reviewed by a Doctor on 5/9/2016
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