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Pediatric Schlemm Canal Surgery: How to Deal With Challenges

  Channels: Glaucoma | Posted 10/3/2018

Zeynep Aktas, MD, FEBO, presents a case of a 20-day-old infant diagnosed with primary congenital glaucoma with a bilateral 40-mm Hg IOP measured under general anesthesia. Corneal diameters were measured as 12 x 12.5 mm bilaterally, and corneal edema was significant. Circumferential trabeculotomy was chosen as a surgical method. Scleral radial incision was made without a flap and Schlemm’s canal (SC) was found. A 6-0 suture (Prolene, Ethicon Inc.) was introduced into SC, and the distal tip could have been advanced but did not reach the ostium. As an alternative method, a proximal suture tip was introduced into the anterior chamber, externalized through the paracentesis incision, and pulled to perform trabeculotomy up to where the distal suture tip got stuck in the SC. A 270-degree trabeculotomy was performed this way. Then additional a 3 clock hour trabeculotomy was performed with a Harm's trabeculotome in the superonasal quadrant so that trabeculotomy was completed circumferentially.

GT Film Fest 2018 • Schlemm canal • trabeculotomy • Zeynep Aktas, MD, FEBO

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