Successful needling of previous failed deep-sclerectomy in a child with primary congenital glaucoma

To illustrate the successful of needling with subconjunctival antimetabolite in failed deep-sclerectomy (DS) in congenital glaucoma. To the best of our knowledge, this is the first report of successful needling of DS in a child with congenital glaucoma.

A 14-year-old boy with unilateral congenital glaucoma in the right eye underwent goniotomy followed by DS two-years ago with no improvement. Upon pre-operative examination, visual acuity was (20/200) improved with pinhole (20/70). The intraocular pressure was 28 mmHg. Under slit lamp, there was a scarred bleb, large clear buphthalmic cornea and 0.9 cup-to-disc ratio in the right eye. The patient was scheduled for needling of failed DS with subconjunctival antimetabolite for right eye under general anesthesia. One year post-operatively, the child maintains best corrected visual acuity of 20/70 with and intraocular pressure of 15 mmHg without the need for glaucoma drops.

Needling of failed DS may be a viable option in childhood glaucoma for maintaining IOP and preserving the other conjunctival quadrants for future glaucoma surgeries.