Primary Congenital Glaucoma Treatment and Management
Medical Care
Primary congenital glaucoma is primarily managed through surgery. Medical therapy is used temporarily before surgery and to help control intraocular pressure post-operatively.
Surgical Care
The main surgical techniques address the resistance to aqueous outflow due to structural abnormalities in the anterior chamber angle. This can be done through:
Goniotomy: Abnormal tissue is incised under direct visualization using goniolens, relieving resistance from the trabecular meshwork.
Trabeculectomy: The Schlemm canal is located by external dissection, and the trabecular meshwork is incised using a probe that is passed into the canal and rotated into the anterior chamber. This method is suitable for cloudy corneas.
Both procedures have a success rate of about 80%. The prognosis is worse in infants with elevated pressures and cloudy corneas at birth. The best outcomes are seen in infants operated on between the second and eighth months of life. Surgery is generally less effective in preserving vision with increasing age.
If initial surgeries like goniotomy or trabeculectomy fail, filtering procedures such as trabeculectomy may be used, with or without antimetabolites. If these also fail, shunts or ciliary body destructive procedures may be considered.