Possible causes of the ineffectiveness of sinustrabeculectomy in children with congenital glaucoma

Abstract

AIM: On the basis of studying the causes of errors in finding the trabecular zone to be excised during trabeculectomy in children with congenital glaucoma, this study presents a proven and effective method for simple intraoperative localization of the trabecular area.

MATERIAL AND METHODS: The analyses of many years of experience in the examination and treatment of children with congenital glaucoma at the Department of Eye Pathology in Children of Helmholtz National Medical Research Center (100–200 children annually) revealed the anatomical and morphological features of the eyes of children with congenital glaucoma and the reasons for the insufficient effectiveness of trabeculectomy.

RESULTS: A retrospective gonioscopic analysis of the condition of the operation area and internal fistula after trabeculectomy in children with congenital glaucoma showed that erroneous choice of the area of the trabecular region to be excised during surgery is one of the reasons for the inefficiency of trabeculectomy, and it results from the incorrect determination of the projection location of the apex of anterior chamber angle (ACA) onto the sclera caused by the significantly distorted anatomical parameters of the child’s eye due to the softness and extensibility of the limbus and sclera. On the stretched eyes of children with congenital glaucoma, especially those with buphthalmos and cloudy cornea, accurate determination of the boundaries of the altered cornea, limbus, and projection of the ACA’s apex onto the sclera is visually impossible.

CONCLUSION: During trabeculectomy of the eyes of children with congenital glaucoma, for the accurate localized projection of the apex of the ACA’s onto the sclera and the trabecular zone to be excised, a simple and accessible method of clarifying diaphanoscopy intraoperatively must be used to correctly select the trabeculectomy zone, especially on stretched eyes.

Keywords

congenital glaucoma / trabeculectomy / diaphanoscopy / children

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