Autosomal dominant juvenile-onset open-angle glaucoma has been mapped to 1q21-31 in a number of American families. Our study confirms linkage in a Danish five-generation dominant juvenile-onset glaucoma family with a maximum two-point lod score of 6.67 at the D1S210 locus. Multipoint linkage analysis in a nine-generation Swedish family with dominant juvenile-onset glaucoma and iris hypoplasia excludes linkage to the region of approximately 18 cM between loci D1S104 and D1S218, shown to contain the previously mapped glaucoma gene. This study thus provides support for genetic heterogeneity with respect to dominant juvenile-onset glaucoma.

In Scandinavia, pseudo-exfoliative glaucoma accounts for approximately one half of cases of open-angle glaucoma (Aasved, 197I) and displays a number of characteristic features that distinguish it from simple glaucoma. The intraocular pressure (IOP) is usually higher and the prognosis poorer. These eyes also display characteristic changes in the anterior ocular segment, including deposition of pigment, flakes, and amorphous material.The medical therapy of pseudo-exfoliative glaucoma is often insufficient and we have therefore chosen to study a microsurgical approach. This paper presents the results of trabeculectomy in 52 eyes. MethodThe surgical technique followed that described by Watson (I969). An operating microscope (Zeiss Op-Mi 7) was used in all cases. Peroral intake of I001-50 ml. 50 per cent glycerine 30 min. before surgery was used for reduction of the IOP.Conventional retrobulbar anaesthesia and akinesia was administered. A large, full conjunctival flap was fashioned with an incision parallel to the corneo-scleral limbus. In the I 2 o'clock position a half-thickness limbus-based scleral flap measuring 4 x 6 mm. was prepared. The lamellar dissection in the anterior direction passed the limbus and entered the corneal tissue. All bleeding vessels were cauterized. The incision into the anterior chamber was placed immediately in front of Schwalbe's line in clear corneal tissue. As a rule the basal iris prolapsed and was perforated with release ofaqueous whereafter spontaneous reposition of the iris took place.A radial cut backwards from the right end of the corneal incision divided the trabecular band, Schlemm's canal, and the scleral spur. The next cut was made in the sclera parallel to and just behind the scleral spur. The uveal meshwork was separated from the trabecular band with open scissors and the trabeculectomy block was then released by a second radial cut at the left end of the corneal incision.A broad basal iridectomy was carried out corresponding to the trabeculectomy and the scleral trapdoor was sutured with virgin silk, using two stitches. The conjunctiva was closed with a running 6-o silk suture. i per cent atropine eye-drops and i per cent chloramphenicol ointment were instilled before padding. The patient was allowed up after dressing on the first post-operative day and discharged on the sixth day.Atropine drops were continued for 5 weeks but no routine steroid therapy was given.

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281 eyes out of 330 were followed during 3 to 5 1/2 years after trabeculectomy. 32 eyes were drop-outs due to death and 17 eyes due to inability to participate in the examination program. The mean age at time of surgery was 66 years. A mean pre-operative IOP of 31 mmHg dropped to a mean post-operative level of 18 mmHg. In 57% a single trabeculectomy was considered enough to control the glaucoma. Post-operative medical treatment was considered necessary in 35%. In 87% the pre-operative progress of the field defect was arrested. A reoperation was performed in 8%. The early complications were very few, but in 25% slowly developing cataract was observed. A cataract extraction was performed in 29 eyes post trabeculectomiam with a favourable visual outcome. This study confirms the opinion that trabeculectomy is an atraumatic and efficient surgical procedure and a necessary therapeutic measure when the tolerable combination of antiglaucoma drugs proves insufficient to control the glaucoma.