Gonioscopy
Gonioscopy provides important information about the mechanism of the pediatric glaucoma as well as evidence of a patient’s prior surgeries. An EUA is usually required for gonioscopic examination of younger children. A Koeppe lens allows direct visualization of the angle structures. In older children, indirect gonioscopy can be performed with a 4-mirror goniolens at the slit lamp.
The normal anterior chamber angle of an infant differs from the normal adult angle in several ways, including a less pigmented trabecular meshwork, a less prominent Schwalbe line, and a less distinct junction between the scleral spur and ciliary body band (Fig 11-10A). In PCG, the anterior chamber is deep, with a high anterior iris insertion. The angle recess is absent, and the iris root appears as a scalloped line of glistening tissue (Fig 11-10B). Although this tissue is not a true membrane, it has been referred to as the Barkan membrane and likely represents thickened and compacted trabecular meshwork (see Fig 1-11).
In eyes with JOAG, the angle usually appears normal. In patients with aniridia, gonioscopy reveals a rudimentary iris root.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.