GONIOPUNCTURE is a filtering operation, developed as a result of experiences with goniotomy, which seems of value in juvenile, and possibly congenital, glaucoma. The operation is done by carrying the tip of a knife, devised for this purpose, across the anterior chamber as in goniotomy; but, instead of sweeping the knife along the angle, a counterpuncture into the subconjunctival space is made through the trabecular region of the corneoscleral wall. When the operation is successful, a permanent fistula is established which permits subconjunctival drainage of aqueous humor, indicated by normalization of tension and diffuse edema of the conjunctiva over the area adjacent to the puncture. A persistent hole usually can be seen by gonioscopic examination in the angle wall at the site of the puncture.
Although the data accumulated are as yet insufficient, goniopuncture seems effective in treatment of juvenile glaucoma and may offer promise in congenital glaucoma. It has