Viscosinusotrabeculotomy in primary congenital glaucoma

Abstract

Primary congenital glaucoma (PCG) is rare inherited eye disorder, which incidence of approximately 1 in 10000 births in Europe and USA. Most cases of PCG occur sporadically. Pathogenesis – morphologic anomalies of the trabecular meshwork & Schlemm’s canal, also common anterior iris insertion & agglomeration of microfibrillar material. The main feature are ocular enlargement, corneal edema & optic nerve cupping. Examination under anesthesia includes measurement of corneal clarity & diameter, intraocular pressure, slit lamp examination, gonioscopy, ophthalmoscopy, ultrasonography. Initial surgical treatment of PCG are – goniotomy, trabeculotomy ab externo, primary trabeculotomy, ab externo combined trabeculotomy & trabeculectomy. Postoperative inflammation, scarring & active regeneration makes instability of surgery results. Hyaluronic acid (HA) is the integral part of the majority of viscoelastics, disclosed the antiinflammatory properties. The developed original method of glaucoma surgical treatment – viscosinusotrabeculotomy allows to preserve the formed outflow pathways of the intraocular fluid due to its temporary intubation by “liquid” implant (dispersive viscoelastic) & reduce the intensity of the inflammatory reaction of injured tissues under the influence of HA in its composition. The usage of the viscosinusotrabeculotomy in PCG (45 children – 75 eyes) was effective in 98,7% of cases in early post op, in 91,2 % in 2 years & in 88,9 % in 3 years follow up period.