In the surgical treatment of congenital glaucoma, the preferred initial procedure for buphthalmos presenting at birth to 2 years of age is:

• A Trabeculectomy with mitomycin C
• B Goniotomy (Barkan's operation) when cornea is clear enough to visualize the angle ✓
• C Combined trabeculotomy-trabeculectomy
• D Ahmed glaucoma valve implant as primary surgery

Explanation

Goniotomy (Barkan's operation) is the preferred initial surgery for congenital glaucoma when the cornea is sufficiently clear (< 14 mm in diameter, no significant corneal edema) to allow gonioscopic visualization. It involves ab-interno incision of the trabecular meshwork under direct gonioscopic view, relieving the trabecular dysgenesis blocking aqueous outflow. Goniotomy is particularly successful (> 80% success) in primary congenital glaucoma presenting in infancy because the trabecular dysgenesis is the primary pathology. Trabeculotomy (ab-externo approach to Schlemm's canal) is preferred when the cornea is too hazy for goniotomy. Combined trabeculotomy-trabeculectomy achieves better IOP control in a single procedure and is favored by many Indian glaucoma surgeons.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.