Primary Congenital Glaucoma (cont.)
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Surgery is performed to allow the fluid inside the eye to drain outside the eye and lower the pressure.
If surgery is needed, the ophthalmologist will discuss the appropriate surgical procedure for the child with the parents or caregivers. The risks and benefits of each procedure will also be explained.
Common surgical procedures
The most common surgical procedures for primary congenital glaucoma are goniotomy and trabeculotomy.
In both procedures, the ophthalmologist makes an incision into the trabecular meshwork to allow the fluid (aqueous humor) to flow out better from the eye using the normal drainage channel.
In goniotomy, the fibers of the trabecular meshwork are cut to eliminate any resistance to fluid flow imposed by an incompletely developed trabecular meshwork.
In trabeculotomy, a probe is used to tear through the trabecular meshwork to open it and allow fluid flow.
One advantage of trabeculotomy is that it can be performed in eyes with cloudy or clear corneas, whereas goniotomy can only be performed in eyes with clear corneas.
Goniotomy and trabeculotomy have similar success rates of approximately 80%.
Alternate surgical procedures
When multiple goniotomies and/or trabeculotomies have failed to reduce IOP, the eye surgeon may perform trabeculectomy, drainage implant surgery, or ciliary body destructive procedures.
Possible surgical complications
As with any surgical procedure, complications may occur but are rare. Serious complications associated with surgery may include the following:
The most serious complications in children are often caused by general anesthesia. In some children, because of the risks associated with anesthesia, both eyes may be operated on at the same time (called a bilateral procedure).
Robert C Urban, Jr, MD
Richard W Allinson, MD
Francisco Talavera, PharmD, PhD
Robert H Graham, MD
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