A newborn has epiphora, photophobia, and blepharospasm with corneal diameter of 13 mm. Examination under anesthesia reveals IOP of 30 mmHg. The primary definitive surgical treatment is:
- A Trabeculectomy with mitomycin C
- B Ahmed valve implantation
- C Goniotomy or trabeculotomy ✓
- D Medical management with timolol eye drops
Explanation
Primary congenital glaucoma is caused by trabeculodysgenesis — maldevelopment of trabecular meshwork and Schlemm's canal. The definitive treatment is surgical: goniotomy (ab interno incision of the trabecular meshwork under gonioscopic guidance) or trabeculotomy (ab externo approach cannulating Schlemm's canal). Both achieve equivalent results with ~80-90% success in uncomplicated cases. Goniotomy requires a clear cornea, while trabeculotomy can be performed with corneal haze. Trabeculectomy is reserved as a second-line procedure; timolol is contraindicated in neonates due to systemic bradycardia.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.