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PURPOSE: The management of glaucoma following cataract surgery (GFCS) in children is challenging. This study looks at the results of two-site trabeculotomy in paediatric aphakic/pseudophakic glaucoma, 1-year post operatively. METHODS: This prospective, institutional study was performed on 33 eyes with GFCS in patients aged ≤14 years. Patients underwent two-site trabeculotomy using the rigid-probe trabeculotome, through a superonasal and an inferotemporal scleral flap. Intraocular pressure (IOP), medications, complications and success rates at 1 year were reported. Success was defined as IOP 180° incision could not be achieved. A 360° incision was achieved in 14 eyes (48%). There was a significant reduction in IOP and medications at 1, 3, 6 and 12 months (p

PURPOSE The purpose of this study was to compare the outcomes of microcatheter-assisted trabeculotomy to circumferential trabeculotomy using the rigid probe trabeculotome in primary congenital glaucoma. METHODS This retrospective study was performed in an institutional setting. The medical records of primary congenital glaucoma patients who underwent circumferential trabeculotomy (≥270 degrees incised) using Glaucolight-illuminated microcatheter or a rigid probe trabeculotome were reviewed. The primary outcomes were the percent reduction of intraocular pressure (IOP) and success rates. Complete success was defined as achieving an IOP

Fiberoptic microcatheter-assisted 360-degree trabeculotomy ab externo is a recent technique. Retrospective studies have proved the effectiveness as a first-angle surgery in eyes with primary congenital glaucoma. However, there are no reports in which it is performed after another unsuccessful surgical procedure. We present our case of a monolateral congenital glaucoma. We first performed an ab externo trabeculotomy with poor control of intraocular pressure (IOP). Then, a microcatheter-assisted 360-degree trabeculotomy was performed with IOP lowering. Microcatheter-assisted 360-degree trabeculotomy supplies successful IOP lowering after another angle surgery procedure.

In this section, we address the role and execution of ab externo trabeculotomy in pediatric glaucoma. We provide an in-depth comparison of different techniques with detailed descriptions of traditional trabeculotomy with metal trabeculotome, ab externo circumferential trabeculotomy with either an illuminated microcatheter or blunted suture filament, and trabeculotomy combined with filtration surgery such as combined trabeculectomy-trabeculotomy and filtering trabeculotomy. For each there are sections on preoperative preparation, execution of the relevant surgery (with tips for problem-solving and avoiding complications), and postoperative management of the child. In addition, there is a comprehensive review of the literature to date, describing the evolution of trabeculotomy in the management of the pediatric glaucomas, and the evidence base for variations in technique, surgical preferences, and outcomes.

Pediatric glaucoma may coexist with other anterior segment disorders, and when 2 surgeries are indicated in children, they are generally performed on separate days. We present 3 cases, documented with video, that illustrate the combination of anterior segment surgery (including cataract extraction and papillary membrane removal) with fiber-optic microcatheter trabeculotomy in infants. In one case, the microcatheter procedure could not be completed, and a trabeculotome was used to complete the trabeculotomy. One patient developed a mild hyphema after microcatheter trabeculotomy, which resolved. All cases were performed without other complications and with satisfactory results.

Traditionally, trabeculotomy is the preferred initial surgical intervention for congenital glaucoma when corneal haze precludes the performance of a goniotomy.1 It was first described by Burian in 1960.2 In the classical trabeculotomy ab externo, an external approach is used to cannulate the Schlemm's canal (SC) and connect it to the anterior chamber through incision of the trabecular meshwork using the trabeculotome. Recent modifications of trabeculotomy include circumferential suture techniques with or without the use of flexible illuminated microcatheter and viscotrabeculotomy.3–5 The most critical step in all these procedures is to identify the SC to prevent the complications such as collapse of the anterior chamber, iridodialysis and misdirection into the suprachoroidal space. The reported incidence of non-localisation of SC during trabeculotomy is 4–15%. Non-localisation may be due to congenital absence or dysgenesis of SC.6 ,7 It is challenging in children due to less pigmented trabecular meshwork, malposition or absence of the canal in children with anterior segment developmental anomalies …

This article details a previously undescribed complication of trabeculotomy occurring in a patient with congenital ectropion uvea and discusses its possible association with an anterior chamber membrane. A 6-year-old boy with congenital ectropion uvea underwent trabeculotomy. After the trabeculotome was swept into the anterior chamber, multiple ovoid and round endothelial and posterior stromal opacities developed in the cornea, and new areas of iris surface irregularities appeared. This is the first reported case of corneal endothelial and iris changes occurring in a patient with congenital ectropion uvea after trabeculotomy without direct endothelial or iris contact from the trabeculotome. The exact cause of these changes is unknown. [Ophthalmic Surg Lasers 1997;28:418-421.]

Purpose To describe and evaluate a new technique that helps identification and unroofing of Schlemm's canal during deep sclerectomy. Design A prospective, interventional case series. Methods This pilot study was conducted on 15 eyes with various types of glaucoma. After dissecting the superficial scleral flap, the trabeculotome was inserted inside the Schlemm's canal. During deep flap dissection, a direct incision was made over the trabeculotomy to open and unroof Schlemm's canal. Five of the excised deep flaps were submitted for histologic examination. Results In 13 of the 15 eyes, the Schlemm's canal was properly identified and unroofed. Schlemm's canal endothelium was identified in all the examined specimens. The mean intraocular pressure was reduced from 26.66 ± 4.54 mm Hg to 12.2 ± 3.5 mm Hg at the end of a mean follow-up of 9.4 ± 2.9 months. Conclusion The insertion of the trabeculotome inside Schlemm's canal before dissection of the deep flap helped Schlemm's canal unroofing.

Purpose To report a new complication of 360 degrees suture trabeculotomy attributable to subretinal suture misdirection. Design Observational case report. Methods Retrospective chart review. Results A 5-month-old female with bilateral congenital glaucoma underwent uncomplicated 360 degrees suture trabeculotomy in the right eye. In the left eye, a scleral flap was created and dissection to Schlemm's canal was achieved. A 6-0 Prolene suture was passed into Schlemm's canal long enough for 360 degrees of treatment, did not come out the opening, and was retracted. The procedure was completed with a trabeculotome. One month later, an unusual white tract was noted subretinally in the left eye. There was no overlying retinal break or detachment. The tract presumably was caused by the misdirected Prolene suture exiting Schlemm's canal prematurely and being directed posteriorly. Conclusions Suture misdirection subretinally during cannulation of Schlemm's canal should be considered a possible complication of 360 degrees suture trabeculotomy.