CONGENITAL GLAUCOMA BEFORE AND AFTER THE INTRODUCTION OF MICROSURGERY

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Abstract
Primary trabeculotomy (in 5 eyes converted to trabeculectomy) normalized the tension in all 21 eyes with congenital glaucoma without associated diseases, (mean postoperative tension 12 mm Hg, range 8-20 mm). Re-operation was needed for only 1 eye. Properatively, glaucomatous cupping was present in 18 of these 21 eyes. Ten of the 18 eyes with glaucomatous cupping were operated upon before the age of 6 mo., 2 before 11 mo. and the appearance of the disc was normalized in these 12 eyes. Repeated trabeculotomy, -ectomy was without success in 3 of 5 operated eyes in patients with congenital glaucoma of several years duration previously treated by macrosurgery. In patients with associated diseases, normal tension was achieved by means of trabeculotomy/-ectomy in 2 eyes in 2 Sturge-Weber children with unilateral congenital glaucoma and in both eyes in a child with a chromosomal defect with bilateral congenital glaucoma. Repeated trabeculotomy/ectomy was unsuccessful in a child with bilateral aniridia with congenital glaucoma and hydrocephalus. Presupposing acute or subacute microsurgery, the present operative results of congenital glaucoma without associated diseases were far better than those obtained in previous decades by macrosurgery which, despite frequent re-operations, effected normalization of the tension in only 61% of the eyes. (Of 26 patients, 11 (42%) with bilateral congenital glaucoma without associated diseases and treated by macrosurgery in previous decades were under the Care of the Blind).