Goniotomy for Juvenile Open-Angle Glaucoma

To report the surgical results of goniotomy surgery for patients with acquired juvenile open-angle glaucoma (JOAG).The medical records of 10 patients with bilateral acquired JOAG were reviewed to learn the results of goniotomy for their glaucoma. Twenty goniotomy procedures were performed for 17 eyes. Sex, ethnicity, family history, refraction, preoperative gonioscopic findings, surgical outcome, age at initial goniotomy, duration of postoperative observation, preoperative and postoperative intraocular pressures (IOP), and glaucoma medication used were reviewed. Complete success was defined as an IOP < or =21 mm Hg, qualified success as IOP < or =21 mm Hg with use of glaucoma medications, and failure as IOP >21 mm Hg despite medical therapy. The surgical technique used to perform the goniotomy procedures was reviewed and the absence of significant complications noted.Overall surgical success was achieved in 77% (13 out of 17) of the eyes. Average IOP for complete success (9 eyes) was 14.7+/-2.1 mm Hg (range: 12 to 18 mm Hg), qualified success (4 eyes) 16.5+/-2.4 mm Hg (range: 14 to 19 mm Hg), and failure (4 eyes) 33.5+/-5.7 mm Hg (range: 30 to 42 mm Hg). The mean age at surgery was 16.3+/-8.1 years (range: 7.3 to 32 y). Mean follow-up interval was 7.8+/-6.2 years (range: 0.1 to 16.3 y). Gonioscopy demonstrated normal appearing filtration angles in all eyes. No significant surgical complications occurred. Mean refractive error was -3.3+/-2.8 (range: 0.0 to -7.8). Sixty percent of patients possessed a family history of JOAG.Goniotomy is a potentially effective initial surgical treatment of JOAG. Goniotomy for JOAG can be successfully performed using a standard goniotomy technique.