[What should be done when surgery fails? Congenital Glaucoma: IOP rises years after surgery].
The treatment for congenital glaucoma is based on surgery, initially nonpenetrating and then penetrating. To start with, a simple trabeculectomy can be augmented by a deep sclerectomy, concentrated Mitomycin C application and iridencleisis. This surgical alternative starts with an "L" shaped conjunctival flap, followed by a superficial scleral flap, then by a deep scleral flap in which bed, Mitomycin C is applied. A trabeculectomy is then performed in the deep sclerectomy. The iris is prolapsed followed by a horseshoe iridotomy in order to suture it in the deep sclerectomy. The scleral flap is tightly sutured and the anterior chamber is filled with viscelastic material. The postoperative treatment consists of topical steroids until the IOP reaches 14mmHg; by then NSAIDs are used for several weeks. If needed, a beta-blocker or acetazolamide can be used during the hypertensive period.
Dahan
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Department of Ophthalmology, University of the Witwatersrand, Oxford Eye Center, Oxford Road Houghton 2198 Johannesburg, South Africa. dahaneli@mweb.co.za
D005901:Glaucoma / Q000150:complications / Q000151:congenital* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D009798:Ocular Hypertension; D013997:Time Factors; D014130:Trabeculectomy / Q000379:methods; D017211:Treatment Failure