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Abstract #26705 Published in IGR 12-3
The role of nasal approach goniotomy after failed temporal approach goniotomy
Gajdosova E; Wren SEM; Moore W; Nischal KKJournal of AAPOS 2009; 13: 16
Purpose: To determine the complication rate and benefit of nasal approach goniotomy (NAG) in those cases where temporal approach goniotomy (TAG) had failed. Methods: We undertook at retrospective case note review of all patients undergoing goniotomy between Sept 1999 and Sept 2008. Results: A total of 57 patients (82 eyes) had 138 goniotomies (94 TAG, 44 NAG). A total of 57 eyes had primary congenital glaucoma only, 14 eyes had portwine stain related glaucoma, 8 were aphakic, and 3 pseudophakic eyes. Mean age at presentation or glaucoma diagnosis was 7.33 months. Mean follow-up was 38.7 months from the last goniotomy. 82 eyes had TAG: 26 of 82 only had TAG and no further surgery, 21 of 82 had TAG, then NAG and no further surgery. A total of 13 of 82 had TAG and further surgery, and 22 had TAG and NAG and further surgery. Mean interval between TAG and NAG where no further surgery was needed was 15.64 months, but this interval was only 6.29 months in those NAGs that failed after failed TAG.Two eyes developed hyphaemas that needed evacuation and both eyes had TAG's. No eyes had lens damage.Atotal of 47 of 82 eyes (57%)were controlled with or without drops by TAG or TAG and NAG. 25% of eyes were spared from filtration/ seton surgery by having a NAG. NAG was not associated with an increased risk of lens damage or hyphaema. Conclusions: NAG should be considered as a second procedure in cases of failed TAG. The longer the time between TAG and NAG the greater the chance of success.
E. Gajdosova.
Classification:
12.9 Trabeculotomy, goniotomy (Part of: 12 Surgical treatment)
