Goniosurgery for prevention of aniridic glaucoma

We conducted a retrospective study to report the long-term success and complications of modified goniosurgery to prevent aniridic glaucoma, an entity that typically is difficult to control medically or surgically.

Fifty-five eyes in 33 patients who had aniridia without glaucoma and who had goniosurgery were identified. Ninety-one procedures were performed on 55 eyes by 1 surgeon (D.S.W.). Each eye had an average of 1.65 procedures and an average of 200 degrees of goniosurgery. Average patient age at time of initial goniosurgery was 37 months. There were no operative complications.

No eye had a decrease in visual acuity at last follow-up. All eyes had a preoperative intraocular pressure (IOP) of less than 21 mm Hg. At last follow-up (average, 9 years 6 months; range, 8 months to 24 years), 49 eyes (89%) had IOP of less than 22 mm Hg without medications. The remaining 6 eyes (11%) had IOP of less than or equal to 22 mm Hg with up to 2 eye drops. Of 224 aniridic eyes of 112 patients that were seen for eye care by 1 of the authors (D.S.W.), 119 eyes (53%) demonstrated glaucoma, as defined by IOP of greater than 21 mm Hg.

Without prophylactic goniotomy, aniridic glaucoma may be expected in half of patients, and when it occurs, it is extremely difficult to control. Prophylactic goniosurgery in selected eyes of young patients with aniridia is effective in preventing aniridic glaucoma.