Last updated: 02/17/2009

Congenital glaucoma does not respond well to medical treatment, so the first line of treatment is usually surgical. Medical therapy is often initiated as adjunct therapy after surgery.

One alternative to goniotomy is trabeculotomy. Goniotomy...

has been the preferred procedure for treatment of congenital glaucoma, but trabeculotomy has been favored in recent years because of the surgeon's difficulty in seeing the structures in the eye when the cornea is hazy. A clear view of the cornea is required for goniotomy. In a trabeculotomy, the surgeon inserts a probe into the eye, passes it through Schlemm's canal, and rotates it inside the anterior chamber in order to tear a hole in the trabecular meshwork. This maneuver creates an alternative passageway for the aqueous fluid to leave the anterior chamber of the eye. In some cases the surgeon will perform a trabeculectomy, a procedure in which part of the trabecular meshwork is removed by cutting, at the same time as the trabeculotomy.

Another alternative procedure involves placement of a filtering shunt to direct the intraocular fluid out of the eye. A shunt is often placed if Schlemm's canal cannot easily be located, as in the case with infants. The safety profile for trabeculotomy and filtering surgery are comparable to goniotomy, but there is a higher rate of long-term success with goniotomies and trabeculotomies.

A newer variation of surgical goniotomy is laser goniotomy, in which the surgeon uses a Yag:Nd laser to cut into the trabecular meshwork. Laser goniotomies appear to be less effective than surgical goniotomies, but if a patient responds well to a laser procedure, then surgical goniotomy may be considered.

Other alternative treatments for pediatric glaucoma are the cyclodestructive techniques, which include cyclophotocoagulation, and the more commonly performed cyclocryotherapy. These procedures involve destruction of the ciliary body by using either freezing temperatures or lasers. These procedures have lower success rates and a higher risk of complications; they are usually performed as a last resort when other techniques have failed.