Results of the modified trabeculotomy in the treatment of primary congenital glaucoma.

PURPOSE: To evaluate the effect of trabeculotomy employing probes with curvatures more closely corresponding to variable course of Schlemm's canal.

METHODS

Forty-six children with primary congenital glaucoma who underwent trabeculotomy with newly designed probes between 1990 and 1998 were evaluated retrospectively. One set of the newly designed instruments consists of 3 pairs of trabeculotomy probes, the curvatures of which correspond to corneal diameters of 10, 12, and 14 mm. The criteria for surgical success were intraocular pressure (IOP) below 21 mmHg and simultaneous absence of cup to disc (C/D) ratio progression and of disproportional enlargement of the cornea.

RESULTS

Forty-six children who underwent surgery over the course of 7 years were evaluated in a follow-up period from 7 to 83 months (38.4 +/- 22.5 months). A total of 102 trabeculotomies were performed in a total of 78 eyes, with the following complications: 8 large intraoperative hemorrhages, 3 small iris prolapses, 2 small descemetolyses, and 1 short iridodialysis. Postoperatively, glaucoma was successfully controlled in 68 eyes (87%), IOP fell in average from 30.81 +/- 6.55 mmHg to 16.32 +/- 5.13 mmHg (P <.00005). Visual acuity was better than 0.4 in 50 eyes and worse than 0.1 in 5 eyes at the end of the study.

CONCLUSION

The probing of the Schlemm's canal was feasible in all procedures and the number of complications was low. The success rate of surgery was high. Adaptation of the trabeculotomy probes to the Schlemm's canal curvature seems to make probing easier and safer.