Trabeculotomy

Congenital glaucoma, especially corneal opacity can not see the anterior chamber angle structure, or 2 to 3 times before the anterior chamber angle incision can not control the intraocular pressure. Treatment of diseases: congenital glaucoma glaucoma Indication Congenital glaucoma, especially corneal opacity can not see the anterior chamber angle structure, or 2 to 3 times before the anterior chamber angle incision can not control the intraocular pressure. Contraindications General anesthesia is not acceptable due to general conditions. Preoperative preparation Preoperative preparation Apply antibacterial eye drops. anesthesia Children need general anesthesia. Surgical procedure 1. For children, re-examine the eye after general anesthesia, including applanation tonometer to measure intraocular pressure and corneal diameter, check anterior chamber angle and optic disc. Once the diagnosis of glaucoma is confirmed, surgery can be performed. 2. Open the device and the upper rectus pull line. 3. The corneal puncture is performed under the corneal margin. 4. Make a 5~8mm wide bulbar conjunctival flap with a limbus above the nose or above the ankle, or a conjunctival flap with a iliac crest. 5. After cauterization on the surface of the sclera, a scleral flap with a length of about 4 mm triangle or quadrilateral and a thickness of about 2/3 scleral thickness and a base of the limbus is made, and is peeled to the limbus, 1 mm before the posterior edge of the limbus. Keep the thickness of the entire scleral flap consistent when peeling off. The triangular scleral flap can fully expose the Schlemm tube and the extent of the scleral removal is smaller than the quadrilateral scleral flap. 6. After increasing the magnification of the surgical microscope, make a radial vertical incision on the posterior edge of the scleral margin in the scleral bed. The purpose is to cut the outer wall of the Schlemm tube. The incision is about 1 mm long. The incision is gradually deepened under careful observation until there is A clear or light red liquid flows out, but the anterior chamber does not become shallow. 7. Carefully identify the Schlemm tube outer wall incision. When the outer wall of the tube is cut, two small black spots are visible at both ends of the cut surface, which are elliptical or crack-like. The incision can be inserted into the incision with a sharp scissors, and the 1 to 2 mm parallel incision is made to enlarge the incision of the outer wall. Insert a 6-0 nylon thread. If the resistance is not large when inserting, the nylon thread is swung back and forth at the incision, and the end of the line is not seen in the anterior chamber to enter the anterior chamber angle. It is generally confirmed that the nylon thread is inside the Schlemm tube. An anterior chamber gonioscopic examination was performed during surgery to confirm that the nylon thread was inside the Schlemm tube. 8. Pull out the nylon thread inserted into the Schlemm tube, and then parallel the curved surface of the trabeculectomy with the limbus, insert the lumen from the Schlemm tube incision, and advance along the limbus to make the front into the lumen. 8~9mm. The trabecular slitter is rotated on the front atrial side to separate the inner wall of the Schlemm tube and the trabecular meshwork. 9. After the trabecula is cut, the anterior chamber is slightly shallower and there will be a small amount of bleeding. In most cases, these conditions generally have little effect on the trabeculectomy of the other side. If the anterior chamber is significantly lighter, inject the balanced saline into the anterior chamber through the corneal puncture and deepen the anterior chamber before doing another trabecular incision. 10. Radial corneal incision is not sutured. The scleral flap was sutured with a 10-0 nylon thread. The bulbar conjunctiva and the bulbar fascia wound are then sutured intermittently or continuously. 11. At the time of surgery, the conjunctiva was injected with gentamicin or tobramycin 20,000 U and dexamethasone 2.5 mg. Use antibacterial eye drops and eye ointment.