A serious complication of goniotomy and goniopuncture has been anterior chamber hemorrhage. In late cases of congenital glaucoma, it has been necessary to repeat the goniotomy once or twice to increase its effect. It may be wise to do a more extensive goniotomy at the first operation, hoping to avoid further surgery. Hemorrhage occurs when a blood vessel has been cut and/or the anterior chamber pressure has been greatly reduced. By doing goniotomy under direct observation, with the surgical goniotomy lens and surgical microscope, while at the same time maintaining a deep anterior chamber and putting the trabeculae on a stretch, the larger vessels can be avoided with the goniotomy knife. By maintaining a high anterior chamber pressure, one also prevents the oozing from smaller vessels.
The following technique may prove helpful. Under deep general anesthesia, a slanting corneal incision is made with a needle knife in the lower temporal
ANDERSON TW. Prevention of Hemorrhage in Extensive Goniotomy and Goniopuncture. Arch Ophthalmol. 1965;73(2):202-203. doi:10.1001/archopht.1965.00970030204011