A Baby with Primary Congenital Glaucoma Not Responding to Trabeculotomy

A 3-month-old girl was diagnosed with primary congenital glaucoma (PCG) at birth. She was born via normal vaginal delivery and was the first child of healthy non-related parents. Ocular findings at birth are listed in Table 1. She underwent trabeculotomy in the superonasal and inferotemporal quadrants of both eyes in one session. The results of examination six weeks after the operation are shown in Table 1 and Figure 1. Timolol 0.5% and dorzolamide 2% eyes drops were started for both eyes and the examination was repeated 6 weeks later which showed no specific change except for intraocular pressure (IOP) reduced to 30 and 28 mmHg in the right and left eyes, respectively. There is no data on axial length, but B-scan sonography of the right eye revealed no posterior segment abnormality or retinal detachment. • What would your management be for this patient? • Do you recommend latanoprost or brimonidine eye drops? • What would your next operation be for controlling IOP? • Do you recommend trans-scleral cyclophotocoagulation? • If corneal opacity does not improve, do you suggest corneal grafting? If so, at what age? George L. Spaeth, MD