AAO 2018 Video Program
    Congenital Glaucoma, Pediatric Ophth/Strabismus

    This video describes tips to identify and locate the Schlemm canal to successfully perform ab externo trabeculotomy. In congenital glaucoma, combined ab externo trabeculotomy and trabeculectomy is the preferred surgical technique. After creating the limbal-based conjunctival flap, superficial scleral flap of appropriate thickness is carefully dissected. Then radial incision is gradually deepened in the area of the Schlemm canal. Once identified, a Harms trabeculotome is used to open the inner wall of the Schlemm canal to communicate it to the anterior chamber.

    Good knowledge about surgical limbus, location of the entry of perforator vessels, and the external dip at the junction of the blue and the white zones are the pointers to the Schlemm canal.

    Identifying the Schlemm canal is the most critical step in performing trabeculotomy and demands training and micro-level surgical skill.