Aniridic glaucoma: the results of gonio-surgery to prevent and treat this problem

Repetitive gonioscopy of children with congenital aniridia confirms the presence of an angle abnormality which can be progressive and cause glaucoma. This abnormality features obstruction of the trabecular meshwork by variable mixtures of anterior migration of the peripheral iris and thickening of the uveal meshwork associated with a vascular net over exposed trabecular meshwork adjacent to the anterior edge of the iris. Preliminary results of prophylactic gonio-surgery in 28 eyes of 16 children with an average age of 4 years was reported. This surgery was performed without complication and produced a permanent exposure of the trabecular meshwork to the anterior chamber for an average of 8 circumferential hours, if two procedures were performed. Preliminary results suggest a stabilization of eye pressures at least through childhood and encourage the continuation of these prophylactic operations on selected eyes with congenital aniridia. Therapeutic goniotomy for established acquired glaucoma in congenital aniridia cannot be relied on, but may be a benefit for early detected cases or for glaucoma associated with aniridia in infancy.