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Technique for identifying Schlemm's canal in paediatric glaucoma surgery
  1. Anagha Medsinge1,
  2. Ken K Nischal1,2
  1. 1Department of Ophthalmology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
  2. 2University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Ken K Nischal, Department of Ophthalmology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, FP 5106, Pittsburgh, PA 15224, USA; nischalkk{at}

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Traditionally, trabeculotomy is the preferred initial surgical intervention for congenital glaucoma when corneal haze precludes the performance of a goniotomy.1 It was first described by Burian in 1960.2 In the classical trabeculotomy ab externo, an external approach is used to cannulate the Schlemm's canal (SC) and connect it to the anterior chamber through incision of the trabecular meshwork using the trabeculotome. Recent modifications of trabeculotomy include circumferential suture techniques with or without the use of flexible illuminated microcatheter and viscotrabeculotomy.3–5 The most critical step in all these procedures is to identify the SC to prevent the complications such as collapse of the anterior chamber, iridodialysis and misdirection into the suprachoroidal space. The reported incidence of non-localisation of SC during trabeculotomy is 4–15%. Non-localisation may be due to congenital absence or dysgenesis of SC.6 ,7 It is challenging in children due to less pigmented trabecular meshwork, malposition or absence of the canal in children with anterior segment developmental anomalies …

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  • Contributors Both authors contributed equally to the manuscript.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.