Endoscopic Goniotomy for Infantile Glaucoma
Condition: Glaucoma
MeSH terms: Glaucoma; Hydrophthalmos
Study type: Interventional

Summary: 
      Glaucoma surgery is performed on children less than 3 years old for infantile glaucoma which
      untreated can cause blindness. Glaucoma is an uncontrolled high eye pressure in these
      children often due to incomplete development of the part of the eye which normally allows
      fluid to drain out of the eye. Two procedures are possible and equal in their success of
      lowering the eye pressure. However, one (the goniotomy procedure) is preferred since it takes
      10 minutes rather than 1 hour (for the trabeculotomy procedure) to perform under general
      anesthesia. This is important in young children to reduce anesthesia exposure especially if
      both eyes need surgery. If the glaucoma has caused the cornea or front of the eye to become
      too cloudy, then the view is too poor to place a lens on the cornea and use a needle to
      perform the shorter procedure. However, a small endoscope which has been FDA approved for use
      in the eye will allow direct viewing of the area which needs treatment. A needle attached to
      this endoscope allows the shorter goniotomy to be performed rather than proceeding to the
      longer trabeculotomy procedure. The outcome measure of this study is anesthesia time and
      reduction in intraocular pressure .
    

Detailed description: 
      b. The standard examination under anesthesia initially will be performed including measuring
      the child's intraocular pressure, measuring dimensions of the eye, examining the front of the
      eye under the operating microscope, examining the portion of the eye where the fluid drains,
      evaluating the back of the eye with an ultrasound, and possible documentation with
      photographs.

      When the diagnosis is confirmed by this examination, the eye or eyes will be carefully
      evaluated for their clarity. If a standard goniotomy procedure can not be done, then the
      endoscopic goniotomy will be performed. The procedure is identical with: cleaning the eyelid
      skin, using a speculum to open the eyelids, making a small cut into the cornea, and placing a
      viscoelastic substance into the eye to maintain its shape. The procedure then differs since
      the inserted needle is attached to the viewing endoscope. I will then view the inside of the
      eye on a TV monitor in addition to looking through the operating microscope. This will allow
      me to directly see the structures which I will need to cut. Normally, I depend upon looking
      through a lens placed on the cornea which must be fairly clear so that I can see to cut the
      structures in the standard procedure. The procedure should not take much longer than the
      standard goniotomy and the same amount of tissue will be cut as in a standard goniotomy. The
      needle is then removed. The remainder of the procedure is identical which includes placing a
      stitch in the corneal incision, adjusting the amount of fluid in the eye so the pressure is
      not too low or high, giving a dilating drop, giving a steroid and antibiotic injection around
      the eye, giving steroid ointment and an eye patch.
    

Intervention name(s): endoscopic goniotomy
Intervention type(s): Device
Intervention description(s): The goninotomy is performed through an endoscope; allowing the physician a better view of the structure within the eye
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: childhood glaucoma