One versus two simultaneous goniotomies as the initial surgical procedure for primary infantile glaucoma.

To evaluate whether a more extensive incision of the tissue adjacent to the anterior trabecular meshwork resulted in more effective control of intraocular pressure (IOP), seven infants with bilateral congenital glaucoma underwent a single goniotomy in one eye and two simultaneous goniotomies at separate sites in the second. Sodium hyaluronate (Healon) was used in all eyes undergoing two simultaneous goniotomies and in three to seven eyes undergoing a single goniotomy. Success was not significantly different, at 1 month or 1 year postoperatively, for eyes which underwent two simultaneous and separate goniotomies. Successful control of IOP was, however, related to the preoperative IOP. Eyes for which the initial procedure was unsuccessful had a significantly higher IOP. The incidence of postoperative hyphemas was less in eyes in which the Healon was used intraoperatively, but the use of Healon did not favorably or adversely affect intraocular pressure control.