An infant presents at 3 months with photophobia, epiphora, and blepharospasm. Examination under anaesthesia (EUA) shows horizontal corneal diameter of 13 mm bilaterally (Haab's striae present), IOP 26 mmHg, and CDR of 0.7. This is primary congenital glaucoma. The DEFINITIVE treatment is:
- A Topical timolol 0.1% as primary treatment
- B Trabeculectomy with mitomycin C as the primary surgery
- C Goniotomy or trabeculotomy as primary surgical treatment ✓
- D Cycloplegic agents to reduce lens-induced aqueous obstruction
Correct answer: C. Goniotomy or trabeculotomy as primary surgical treatment
Explanation
Primary congenital glaucoma results from an isolated developmental anomaly of the trabecular meshwork (dysgenesis of the angle), making goniotomy or trabeculotomy the definitive surgical treatment. These procedures directly open the dysgenetic trabecular tissue, restoring physiological aqueous outflow. Medical therapy (topical timolol, carbonic anhydrase inhibitors) is used as temporizing bridge before surgery. Trabeculectomy with MMC is not the primary procedure — it is reserved for failed angle surgeries. Cycloplegics have no role in congenital glaucoma management.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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