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SUMMARY
Goniotomy is a safe effective procedure in isolated trabeculodysgenesis occurring in children under the age of two years, and is preferred by the authors in all such cases when visibility allows. It may also be effective for varying periods of time in Sturge- Weber syndrome, Aniridia, Axenfeld's syndrome, and Lowe's syndrome when these occur in infancy.
Trabeculotomy is generally preferred in children with trabeculodysgenesis over the age of three years, in situations where corneal clouding prevents adequate visualization of the trabecular meshwork, and in patients with aniridia. In the latter group, although goniotomy can be effective, its success rate is low, The absence of iris covering the lens does increase the risk of lenticular injury and, therefore, trabeculotomy is usually chosen.
Goniotomy and trabeculotomy are both ophthalmic surgical procedures which modify the drainage apparatus in the irido-corneal angle. They are generally employed in treating the various forms of developmental glaucoma. Both have been used in adult forms of glaucoma, usually with relatively poor success.
The following discussion outlines the authors' utilization of these procedures in various forms of glaucoma, with perceived advantages and disadvantages of each procedure. It must be understood that bias often plays a role in selection of a surgical procedure. The surgeon is influenced by familiarity with the technique as well as assessment of apparent advantages and disadvantages.
Goniotomy and trabeculotomy are distinctly different operations, and experience has led us to recognize distinctly different indications for their use.
Goniotomy was introduced by De Vincentiis in the late 19th century1 and repopularized by Otto Barkan in 1938.2 It has been used in adults with poor success but has been a highly effective operation for curing certain forms of developmental glaucoma.3
Trabeculotomy was introduced by Burian and Allen4 and Smith,5 and popularized by Harms and Dannheim, who also tried the procedure in adults with minimal success.6 In general, it is now reserved for use in cases of developmental glaucoma or young adult cases of openangle glaucoma.
Technique - Goniotomy
The basic technique for goniotomy involves the introduction at the limbus of a needle-knife which is passed across the anterior chamber to engage the trabecular meshwork on the opposite side of the eye. The meshwork is then incised approximately in its midportion...