• Recommended originally as surgical treatment
for both primary infantile glaucoma and
primary open-angle glaucoma.
Primary infantile glaucoma
• when angle structures cannot be visualized
through a cloudy cornea.
• After the failure of two goniotomies.
Juvenile open-angle glaucoma
• Long-term results are impressive in managing
infantile glaucoma and open-angle glaucoma
in younger adults.
• Trabeculotomy has a high success rate (80–
• less useful in older patients with chronic
open-angle glaucoma unless there are angle
changes compatible with juvenile anomalies.
• High magnification
• Depper scleral dissection.
• canal is found in the corneoscleral sulcus
at the blue-grey/white transition
between scleral and corneal tissue.
• Using high magnification (16x to 25x),
• cellulose sponge can dry the junction and
allow for the appreciation of droplets of
clear aqueous beading precisely above
• A radial incision 2 mm in length is made
at that point.
• As the canal is approached, there is a
seeping of aqueous and often a tinge of
blood as the outer wall of the canal is cut
To ensure the accuracy of the incision
3 cm of 5-0 or 6-0 monofilament (e.g., Prolene or
nylon) suture with a beveled tip.
Entered 5 mm.
suture should enter easily and slide into the eye
following the course of the canal.
not be possible to rotate the suture anteriorly into
either the anterior chamber or posteriorly into the
The suture may be viewed gonioscopically to be sure
of its proper positioning.
• catheter with an LED on the end which allows
visualization of the catheter as it transits the
360° of Schlemm’ canal.
Harms or McPherson trabeculotome
• Probe centripetely
• Parallel to iris plane.
• If more ANT – desment
• If more POST- lens
Purse-string 360° trabeculotomy
• reported to have an excellent ‘success’ rate for pressure
control comparable to or better than goniotomy and
trabeculotomy with metal trabeculotomes.
• One complication of this procedure is that the Prolene
suture or the catheter can be misdirected into either
the anterior chamber or, more ominously, into the
• can also be done with the Icath.
Combined trabeculotomy and
• long-term outcome of mitomycin-C
trabeculectomies was similar to that of
Ahmed valve implants.
• complications were greater for the
• whereas the Ahmed group was morelikely to
need subsequent medications to control the
Glaucoma secondary to juvenile
rheumatoid arthritis (Still’s disease)