Hyphema Research Articles

Indoor soccer-related eye injuries: should eye protection be mandatory?

Our objectives were to present the spectrum of eye injuries caused by indoor soccer, as seen at our institution, and to initiate discussion as to whether eye protection should become mandatory for this indoor sport. Chart review of patients presenting to our institution with eye injuries from indoor soccer. Five cases were identified from 2001-2005, all occurring during the winter or late fall. Each injury was due to contact with the soccer ball itself. Initially, all 5 patients presented with commotio retinae (1 with a prominent retinal and vitreous hemorrhage and 2 with smaller retinal hemorrhages), 2 with hyphema and traumatic mydriasis, 1 with subconjunctival hemorrhage, and 1 with upper lid edema and ecchymosis. Three resolved uneventfully with 20/20 or better vision; however, in 2 there were findings of choroidal rupture with chorioretinal scarring. One of these had 20/20 vision and a discontinuous choroidal rupture peripherally, and the other had 20/40 vision and extensive chorioretinal scarring. One patient also showed a peculiar persistent iris scar. Soccer-related eye injuries have been recognized as an important ophthalmologic problem in Europe and now increasingly so in North America. With the increasing popularity of indoor soccer in Canada, serious eye injuries have become more prevalent. On the basis of the prevalence and the nature and mechanism of the ocular trauma, we believe there may be a need to make eye protection mandatory for all forms of soccer.

Cataract surgery with small incision under the limbal conjunctiva

Objective To explore the effects and complications of manual cataract extraction and IOL implantation with small incision under the limbal conjunctiva.Methods Cornea conjunctiva tissue Was incised with 45°beveled direction,0.5 mm after the junction of limbus and conjunctiva from 9'clock to 12'clock,with depth of 1/2 cornea and width of 5.5～6.0 mm.The tunnel incision Was produced up to clear cornea with length of 2.0 mm and then punctured into the anterior chamber.After continuous curvilinear capsulotomy or capsulorhexis and manual expulsion the nuclear,IOL Was implanted.1293 eyes of 1210 pa-tients were observed,visual acuity,corneal curvature,slit lamp microscope examination and A/B ultrasonic inspection were recorded before and after surgery.The patients were followed up for 4 to 6 weeks.Results The visual acuity:light pemepfion to 0.15 preoperatively and 0.05 to 1.0 postoperatively.The corneal curvature:K1=(43.99±1.83)D,K2=(43.83±2.06)D preoperatively and K1=(45.08±2.30)D,K2=(44.07±2.86)D postoperatively(U test,P＞0.5).The incision of 6 eyes appeared split and iridoptosis,accounting for 0.46%.Corneal edema and exudation in anterior chamber were relatively slisht.There were no hyphema,lens dislocation,infection or other complications.The operation time Was about 5 to 8 minutes.Conclusion Manual cataract extraction and IOL implantation with small incision under the limbal conjunctiva possess simple operation,easy to master,and shorter operative time,fewer complications,faster wound healing. Key words: Limbus; Small incision; Manual cataract extraction

Epidemiology of canine glaucoma presented to University of Zurich from 1995 to 2009. Part 2: secondary glaucoma (217 cases)

To investigate the epidemiology of canine secondary glaucomas in the cases presented to the University of Zurich, Vetsuisse Faculty (UZH) from 1995 to 2009 focusing on possible risk factors for developing secondary glaucoma in this population of dogs. Information was obtained from the computer database of patients examined by members of the UZH Ophthalmology Service, between January 1995 and August 2009. Secondary glaucoma was diagnosed based on the presence of antecedent eye conditions. The data was evaluated for breed, gender, age at presentation, and for antecedent eye conditions known to cause glaucoma including anterior uveitis of unknown cause (AU), lens luxation (LL), intraocular surgery (SX), intraocular neoplasia (IN), unspecified trauma to the globe (T), ocular melanosis (OM), hypermature cataract (PY), hyphema (HY), and six other less frequent conditions. A total of 217 dogs were diagnosed with secondary glaucoma from 1995 to 2009. The age of the dogs with secondary glaucoma ranged between 88 days and 19 years (mean 7.7 ± 3.6 years). Data suggested a predisposition for secondary glaucoma in the Cairn Terrier and the Jack Russell Terrier breeds from 2004 to 2009. Common causes of secondary glaucoma from 1995 to 2009 were AU (23.0%), LL (22.6%), SX (13.4%), IN (10.6%), T (8.3%), OM and PY (both 6.9%) and HY (3.23%). The report presents the epidemiology of secondary glaucomas presented to UZH from 1995 to 2009. Fourteen risk factors were recorded for secondary glaucoma. This is the first paper documenting OM in the Swiss Cairn Terrier dog population.

Diagnosis and management of a spontaneous hyphema from a microhemangioma suspended in the anterior chamber: a case report.

Diagnosis and management of a spontaneous hyphema from a microhemangioma suspended in the anterior chamber: a case report.

Clinical compartion of Suture fixation of posterior chamber intraocular lens and anterior chamber intraocular lens implantation

Objective To investigate the posterior capsule can not be supported by better artificial lens implantation surgery. Methods In our hospital posterior chamber intraocular lens suture fixation(65 cases) and anterior chamber intraocular lens implantation(54 patients) compared the clinical follow-up. Results off residual rate( corrected visual acuity ＞ 0. 3 ) difference was not statistically significant, suture fixation of intraocular lens group a higher incidence of displacement, there were significant differences between the two groups, early high intraocular pressure group the incidence of anterior chamber high significant difference between the two groups, but a month after the incidence of high intraocular pressure was no significant difference between the two groups, corneal edema ,uveitis ,hyphema, the incidence of deformed pupil was no significant difference between two groups. Conclusion Anterior chamber intraocular lens implantation, surgery is relatively simple, with few complications. Key words: Intraocular lens; Suture fixation; Anterior chamber

Clinical analysis of 70 patients with contusive hyphema

Objective To investigate the more effective treatment for contusive hyphema through analysis of clinical data. Methods Clinical data on 70 eyes of contusive hyphema were analyzed. Early stop bleeding and combined modality therapy was put in practice,and surgical treatment should be done when secondary glaucoma and secondary keratohemia was occurred. Results The hyphema was absorbed in 62 eyes. 6 eyes with secondary glaucoma and 2 eyes with secondary keratohemia took place which were done by surgical treatment and intraocular pressure were normal and cornea was almost clear after surgical treatment. Conclusion For contusive hyphema,early stop bleeding, promoting hemorrhage absorption etc was key treatment. For patients with severe complications such as secondary glaucoma,secondary keratohemia,surgical treatment should be done in time. The effect of treatment was satisfied. Key words: Hyphema; Contusions

Nursing in patients with refractory glaucoma undergone ahmed valve insertion with donor human sclera patch

Objective To summarize the nursing points of the patients with refractory glaucoma un-dergone ahmed valve insertion with donor human sclera patch.Methods The nursing points of 102 con-secutive refractory glaucoma cases who underwent ahmed glaucoma valve implant insertion with donor hu-man sclera patch placed over the tube were studied retrospectively.Results 100 (98.04%) glaucoma-tous valves kept on being unobstructed postoperatively.Complications occurred in some patients including hyphema(5 cases), tube exposure (1 cases), shallow anterior chamber(16 cases), hypertension accom-panied with eye pain, headache, and corneal edema early after surgery (14 cases received paracentisis within 3 days), tubes obstructed by the vitrous needed vitrectomy (3 cases), obstructed by silicon oi1(2 cases).Conclusions Paying attention to psychological nursing and health instruction preoperatively, close observation after surgery, and correct instructions for the out- patients, are the key points in the reha-bilitation process after ahmed valve insertion with donor human sclera patch. Key words: Glaucoma; Ahmed valve insertion; Nursing

Trabeculectomy combined with mitomycin C and adjustable suture

Objective To discuss the effect of trabeculectomy combined with mitomycin C and adjustable suture. Methods 78 eyes of 58 patients with glaucoma were under combined-trabeulectomy with one piece of 0.25mg/ml mitomycin C soaked cotton lobe under scleral flap for 3minites during surgery. In suturing scleral flap tire stitch span were increased in order that it would be easy to cut off for IOP control. Postoperative lOP, conditions of filtered bubble and anterior chamber were followed up for 6 months. Results All patients were successfully underwent combined-trabeulectomy to form content filtered bubble. During 6 months follow up, the IOP were effectively controlled, hy student＇s t test p 〈 0. 001. The main complication were early stage shallow anterior chamber and minimal hyphema. Conclusion The use of 0.25 mg/mL mitomycin C during surgery is profit to get long-term effectual filtered bubble. Combined with broken the scleral suture, the lOP control will be more ideal and decreased the side effect such as shallow of anterior chamber. Key words: glaucoma; trabeculectomy; mitomycin C; adjustable suture

Effect of Fufang Xueshuantong capsule on traumatic hyphema.

Objective To evalutate the effect of Fufang Xueshuantong capsule on traumatic hyphema. Methods 64 patients with hyphema caused by trauma were retrospectively studied. They were given Fufang Xueshuantong capusule, 3 capsules one time, three times daily. Results The hemorrhage in anterior chamber was absorbed in 3 days after treatment in stage Ⅰ , in 5 days in stage Ⅱ, and in 10 days in stage Ⅲ respecttively. Conclusion Fufang Xueshuantong capsule is satisfied for patients with hyphema. Key words: hyphema; Fufang Xueshuantong capsule

The technique and observation of closed stitching recovery for Iridodialysis

Objective Iridodialysis is a common complication of closed incarcerated ocular trauma. Re-covery by reduction is the most effective stitching method. There are two methods of stitching:corneoscleral edge incision method and closed stitching method. The author has achieved better results with closed stitching meth-od. Methods In the cases of Iridedialysis,there are various types of complications,e, g. hyphema and pigmen-ted retina inflammation. The surgery is better performed after treatment in (3-7 days after treatment). Perform stitching fixation beneath the sclera flap on the cornenscleral edge of Iridedialysis. Based on the length of separa-tion,determine the counts of stitching (1-4 stitches) ,bury the end of stitches under the selera flap,with the re-duction and recovery of conjunctival flap. Results Our hospital has treated 32 cases of Iridodialysis,with com-plete recovery in each case. After the surgeries,26 cases were found with centralised pupils,4 cases with cent-ralised pupils shghtly oval-shaped,2 cases with deviated pupils,2 cases with angle recession and ocular hyper-tension. After sugeries,21 cases are found with adjusted vision of 0.5-1.0 (65.6%),6 with 0.3-0.4,2 with 0.1-0.2 (6.2%),1 with below 0.1 (3.1%). The cases with poor eye visions suffer from ocular hypertension, angle recession,vitreous hemorrhage,and etc. Conclusion For the Iridedialysis caused by incarcerated closed ocular trauma, the stitching fixation beneath sclera flap can be performed at an appropriate time after treatment to achieve desirable results. Therefore, this surgery method can be applied. The closed stitching method can mini-mise the stimulation to eye balls with rapid recovery of eye vision, and formation of a centralised pupil in a satis-factory shape of round or near-round. However,recovery of eye vision is not as good for those cases with serious eye trauma resulting in vitreous hemorrhage, angle recession, retina mutation, and visual neuro trauma. Key words: Iridodialysis; Stitching fixation beneath sclera flap

Clinical characteristics of occult scleral rupture

To evaluate the clinical characteristics and therapeutic efficacy of occult scleral rupture. It was a retrospective case series. Clinical data of 28 patients (28 eyes) with occult scleral rupture in recent 10 years was reviewed. All patients were performed with I-stage debridement and suturing surgery when the scleral ruptures were confirmed by operation search, and fourteen eyes of them were performed II-stage vitrectomy in following up periods. In 28 cases with occult scleral rupture, the major clinical signs included bulbar conjunctival edema and subconjunctival hemorrhage (100%), vitreous hemorrhage (89.3%), hyphema (78.6%), ocular hypotension (75.0%), limitation of ocular movement (75.0%), reduction of visual acuity to light perception or less than light perception (67.9%), impairment or dislocation of the lens (39.3%), pupilla distortion or dilatation (35.7%), choroidal hemorrhage or detachment (35.7%) and retinal detachment (32.1%). In 23 patients their eyes were scanned by A/B-ultrasonography, the image of eyeball wall were found to be interrupted or disorder in 5 eyes and the ocular axis was shorten in 4 eyes. X-ray computed tomography (CT) were performed in 10 patients before operation. It was found interruption or unsharpness of ocular ring in 3 eyes, the unevenness of ocular density in 2 eyes, and both signs were seen in 5 eyes. Total 28 eyes, the visual acuity were improved in 18 eyes after operation, no change 9 eyes and decreased 1 eye. Visual acuity was significantly increased postoperation (X2 = 13.29, P < 0.05). The result showed that the visual acuity increased in 21.4% (6/28) of eyes with I-stage operation and 85.7% (12/14) of eyes with II-stage vitrectomy respectively. The major sign of diagnosis of occult scleral rupture are visual acuity with light perception or less than light perception, bulbar conjunctival edema and subconjunctival hemorrhage, hyphema, ocular hypotension and limitation of ocular movement, etc after ocular trauma. The intraocular damage such as impairment or dislocation of the lens, vitreous hemorrhage, retinal detachment etc. , is regarded as the important references in the diagnosis, treatment and prognosis. The rates of misdiagnosis can reduce if auxiliary examinations of A or B-ultrasonography and CT are applied. The prompt and appropriate surgery play an important role in the recovery of visual function.

Long-term follow-up of flexible open-loop anterior chamber intraocular lenses implantation

To evaluate the long-term outcome in eyes had flexible open-loop anterior chamber intraocular lens (ACIOL) implantation. Cataract extraction with primary flexible open-loop ACIOL and anterior vitrectomy were performed in 34 eyes (group I), and secondary AC IOL implantation were performed in 49 eyes (group II). Visual acuity, intraocular pressure (IOP), corneal endothelial cell, anterior chamber angle and the presence of associated complication were examined in a mean follow up of 4.8 years (range 3 to 7 years). The final best correct visual acuity was 0.5 or better in 65 eyes (78.3%). The IOP were (13.55 +/- 3.21) mm Hg preoperatively and (13.40 +/- 4.29) mm Hg (1 mm Hg = 0.133 kPa) at the last follow-up (t = 0.5427, P = 0.5888). In group I, the corneal endothelial cell density were (2497 +/- 629)/mm(2) preoperatively, while at the last follow-up it was (1995 +/- 648)/mm(2) and the rate of endothelial cell loss was (20.6 +/- 14.1)%; In group II, the corneal endothelial cell density before and after operation was (2459 +/- 681)/mm(2) and (2238 +/- 817)/mm(2) respectively. The rate endothelial cell loss was higher in group I compared with group II (P = 0.023). Postoperative complication include transient secondary glaucoma caused by block of pupil in 4 eyes and remain of viscoelastic substance in 3 eyes, hypotension in 5 eyes, persistent glaucoma in 2 eyes, hyphema in 2 eyes, IOLs slightly dislocation and shift in 3 eyes, pupil deformation in 1 eye, retina detachment in 2 eyes, and corneal decompensation in 2 eyes. Flexible open-loop ACIOL is relatively safe and effective in selected cataract surgery. Postoperative complication could be reduced if operative indication and surgical technique were emphasized.

The effects of early operation in severe hyphema

目的 观察严重前房积血早期手术治疗的效果.方法对83例(83眼)严重前房积血进行前瞻性分析,观察早期手术组(眼挫伤后72小时内手术)和对照组(伤后72小时后手术)的治疗效果和并发症.结果早期手术组的视力恢复优于对照组,而且角膜血染、虹膜萎缩等并发症的发生率低于对照组.结论严重前房积血早期手术治疗可减少并发症,获得较好的视力恢复。

Clinical signs and differential diagnosis of iris melanoma

Iris melanoma is the rarest type of uveal melanomas. Only 4-5% of uveal melanomas occur on the iris. Although the iris can be easily examined due to its location, differentiation of melanocytic malformations such as naevi or melanomas is difficult for the examiner. According to publications by Rones and Zimmermann, histological examinations showed 22% of tumors to be malignant and 78% to be benign. This lead to iridectomy and iridocyclectomy as therapeutic solutions to gain ground over enucleation. Follow-up of the clinical signs, transillumination, ultrasonic biomicroscopy, iris fluorescein angiography and photo-documentation of the clinical signs can be of great help in diagnosis of pigmented iris tumours. Growth of the tumour, secondary glaucoma, hyphaema, significant vascularisation of the tumour and increasing extent of pigmentation can be signs of malignant behaviour.

The application of ultrasound biomicroscope in diagnosis of ciliary body dialysis after surgical treatment of traumatic hyphema

目的 探讨超声生物显微镜(UBM)在挫伤性前房积血术后睫状体脱离诊断中的应用价值.方法2001年1月～2004年10月收治的Ⅲ级前房积血25例(25眼),首诊均曾作UBM检查未发现有睫状体脱离.行手术治疗后再次应用UBM检查并对眼前段形态结构进行定量测量.检查结果采用配对t检验,进行统计分析.结果25例术后前房积血均完全消失,视力均有不同程度的提高,眼压控制在21.0 mmHg以下;术后第2天UBM检查,睫状体脱离15例,其中全脱离10例,部分脱离5例,未沟通型者13例,沟通型者2例;术后睫状体脱离患者眼压较未脱离者低;睫状体脱离眼与对侧眼比较具有前房浅、睫状体厚度增加和小梁睫状体距离缩短的形态学改变,差异有统计学意义(P＜0.05);睫状体脱离于术后第14天均复位.结论挫伤性前房积血术后睫状体脱离大部分为未沟通型,2周内睫状体脱离复位;UBM对诊断睫状体脱离具有重要的应用价值。

Improved methods for clearance of hyphema

目的 评价采用白内障注吸针头行前房积血清除术的疗效.方法对56例(56眼)外伤性前房积血伴继发性青光眼(前房积血占前房空间2/3以上)经药物治疗无效者,采用白内障7号注吸针头行上方3 mm长的巩膜隧道切口清除前房血块.术中先用黏弹剂充分分离血凝块,然后用白内障7号注吸针头吸出前房血凝块.术后密切观察前房情况、眼压和视力.结果此种方法清除前房血块比较容易,对虹膜和晶状体均无损伤,术后1周前房完全清亮,角膜透明,均无角膜血染发生.54例眼压恢复正常,2例需要药物辅助控制眼压.术后视力明显提高.结论此种术式操作简单,术中安全,术后并发症少,是清除前房积血的有效办法。

The early postoperative complications and cost-effectiveness analysis of non-penetrating trabecular surgery in patients with primary open angle glaucoma

To compare the early postoperative complications of non-penetrating trabecular surgery (NPTS) and modified trabeculectomy (MT) in patients with primary open angle glaucoma, and to analyze the cost-effectiveness of NPTS to prevent adverse events as well. One hundred and forty seven consecutive cases (215 eyes) with primary open angle glaucoma from the glaucoma division, Zhongshan Ophthalmic Center, were involved. One hundred and four eyes underwent NPTS; while 111 eyes underwent MT. Visual acuity, intraocular pressure and complications occurred while staying in the hospital, were recorded. Number of need to treat (NNT) was used to analyze the cost-effective for NPTS. (1) Visual acuity decrease over 2 lines occurred in 25 eyes (24.0%) in NPTS group and 26 eyes (23.4%) in MT group. The difference of visual changes between these two groups was not statistically significant (P > 0.05). (2) One day after the operation, hypotension [IOP less or equal to 5 mm Hg (1 mm Hg = 0.133 kPa)] occurred in 39 eyes in NPTS group (38.2%), and 10 eyes in MT group (9.2%). The difference was significant (P < 0.01). On the day of discharge, the incidence of hypotension was 27.5% in NPTS group and 17.3% in MT group, respectively. The difference was still significant (P < 0.05). (3) Hyphema was found in 20 eyes (19.2%) in NPTS group and ten eyes (9.0%) in MT group. In either group, a surgical procedure was needed in two eyes to evacuate the blood. (4) Two eyes of grade II degrees and five eyes of grade I degrees shallow chamber were found in NPTS group. Five eyes of grade II degrees and five eyes of grade I shallow chamber were found in MT group. The difference of incidence of shallow chamber between these two groups was not statistically significant (P > 0.05). (5) Other complications: In the NPTS group, trabeculo-descemetic membrane rupture occurred in one eye, pupil dilated to 7 mm observed in six eyes; in the MT group, acute elevated IOP occurred in one eye, peripheral anterior synechia at inner incision occurred in one eye, hypotensive macular edema occurred in one eye. (6) The absolute risk ratio (ARR) of NPTS for adverse event was 3.0%, (NNT = 33.2), it costs additional RMB yen 116, 100 for preventing one adverse event. For serious adverse event, ARR = 1.8% (NNT = 55.5), and it costs additional RMB yen 194, 000 to prevent one serious adverse event. Although the NPTS may reduce the incidence of serious adverse event in comparing with MT, the cost of NPTS is very high, therefore, it is not an optimal procedure in China. Ophthalmologists in the general hospital should familiar with the MT procedure to save the medical expenses.

Combined penetrating keratoplasty with keratolimbal allograft transplantation in the treatment of severe corneal burns

To study the clinical results of combined penetrating keratoplasty with keratolimbal allograft transplantation in the treatment of severe corneal burns. The present study consisted of 35 eyes (34 patients) with full thickness corneal opacities and extensive corneal conjunctivalization after severe corneal burns. The duration between the injury and the time of presentation ranged from four months to 23 years. Group A: Combined penetrating keratoplasty (PK) with annular keratolimbal allograft transplantation (KLAT) was performed in 19 eyes (18 patients). Group B: Total PK with a scleral rim was performed in 16 eyes (16 patients). Post-operative visual acuity, intraocular pressure, graft rejection and complications were monitored. The average follow up time was 24 (range from 15 to 28) months. (1) Vision: The number of eyes that obtained best corrected visual acuity > 0.05 was 18 eyes (95%) in group A and 14 eyes (84%) in group B at 6 months postoperatively (P = 0.582); 16 eyes (88%) in group A and 6 eyes (38%) in group B at 12 months (P = 0.006); 12 eyes (63%) in group A and 3 (7%) in group B at 24 months (P = 0.016). (2) Graft rejection: Nine allografts (47%) in group A and 8 grafts (50%) in group B developed limbal stem cell rejection (P = 1.000); 6 allografts (32%) in group A and 11 allografts (69%) in group B developed endothelium rejection (P = 0.044). The difference of endothelium rejection rate between group A and B was not significant at different times postoperatively. (3)COMPLICATIONS: Corneal epithelium defect occurred in 2 eyes (11%) in group A and 7 (44%) eyes in group B (P = 0.049); hyphema occurred in 2 eyes (11%) in group A and 8 eyes (50%) in group B (P = 0.022); hypotony occurred in 1 eye (5%) in group A and 6 eyes (38%) in group B (P = 0.032). PK combined with KLAT is an effective treatment for severe corneal burns at a late stage irrespective of the etiology. This procedure can restore visual function in severely damaged eyes. Patients treated with PK combined with KLAT show less complication and better prognosis as compared with patients treated with total PK with a scleral rim.

Clinical analysis of 78 cases of traumatic hyphema in children

目的 探讨儿童外伤性前房积血的治疗及预后.方法回顾性分析78例(90眼)儿童外伤性前房积血临床资料.结果儿童外伤性前房积血致伤物呈多样性,常见的并发症有继发性青光眼、外伤性白内障及角膜血染等.积极治疗可避免严重的视力损害.结论加强防护,早发现,早期降眼压、抗感染及促进积血的吸收,根据病情及时手术,减少和预防并发症,以恢复视功能。

Long-term effect of trabeculotomy on primary congenital glaucoma

To evaluate the long-term effect of trabeculotomy on primary congenital glaucoma. This retrospective study included primary congenital glaucoma patients who underwent trabeculotomy as an initial surgery between 1988 and 1999 with follow-up at least one year. Definitions of successful operation were determined as (1) intraocular pressure (IOP) </= 21 mm Hg with clear cornea, (2) no antiglaucoma medication or only local medication of topical antiglaucoma drops, and (3) no adverse progression in cup-disc ratio (C/D) and cornea diameter, or cup-disc ratio (C/D) and cornea diameter reduced compared to pre-operation. The study included 33 eyes with 72.7% patients who were followed-up for over three years. The mean follow-up time was (54.2 +/- 33.2) months. After trabeculotomy, the average IOP was significantly lowered to (16.1 +/- 6.2) mm Hg from (29.9 +/- 11.7) mm Hg (P < 0.001); and cornea diameter was significantly reduced to (12.9 +/- 1.0) mm from (13.7 +/- 1.4) mm (P = 0.002). Although there was no significant difference in the average C/D after operation (P = 0.148), the change in C/D was significantly different in patients in the success group [(0.7 +/- 0.2) mm, pre-operation, (0.6 +/- 0.3) mm, post-operation, P = 0.007]. Based on the criteria for successful operation, the success rate of trabeculotomy was 97.0%, 93.2, 74.5% at one, three and five years by Kaplan-Meier analysis respectively. For 20 eyes which received only one operation, the success rate was 70.0%. However, in the rest of 13 eyes (39.6%) that had received two or more operations, the success rate was reduced slightly to 69.2%. In patients with successful operations, 41.7% of patients had correct visual acuity >/= 0.4, 29.1% between 0.1 and 0.3, and 29.2% </= 0.1. By linear regression analysis, it was found that C/D > 0.8 (P = 0.013) was risk factor responsible for poor vision. Among 18 eyes that were examined for visual field, glaucomatous visual field loss was found in 14 eyes (77.7%). Early-stage defect was seen in 42.8%, intermediate-stage in 28.6%, and late-stage in 28.6% of eyes. Hyphema was found in 14 eyes (42.4%). However, hyphema in 10 out of 14 eyes (71.4%) was absorbed in just one day. Therefore, hyphema should not be considered as a high risk for surgical failure (P = 0.795). Trabeculotomy had a high success rate in treatment of primary congenital glaucoma with fewer complications during the follow-up time. Observation from repeated operations also showed satisfactory results. Therefore, the optimal goal in preserving useful visual acuity and visual field is to obtain better control of glaucoma with trabeculotomy and treatment of amblyopia.