A neonate presents with buphthalmos, photophobia, lacrimation, and corneal oedema. IOP is 32 mmHg in both eyes. The definitive surgical treatment is:

• A Trabeculectomy with mitomycin C
• B Ahmed glaucoma valve implant
• C Cyclodiode laser photocoagulation
• D Goniotomy or trabeculotomy ✓

Explanation

Primary congenital glaucoma (PCG) results from trabeculodysgenesis — maldevelopment of the trabecular meshwork and Schlemm's canal. The definitive surgical treatment is either goniotomy (ab interno incision of the trabecular meshwork under direct gonioscopic visualisation) or trabeculotomy (ab externo cannulation and rupture of Schlemm's canal). Success rates are 75–95% for both procedures when performed early. Medical therapy (topical beta-blockers, CA inhibitors) is temporising before surgery. Trabeculectomy is reserved for cases failing primary angle surgery.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.