Childhood glaucoma surgery in the 21st century

Microcatheter-assisted Trabeculotomy for Primary Congenital Glaucoma After Failed Glaucoma Surgeries

PURPOSE

To evaluate the effectiveness of microcatheter-assisted trabeculotomy (MAT) to treat primary congenital glaucoma after failed previous glaucoma surgeries.

MATERIALS AND METHODS

Retrospective, noncomparative, interventional case series conducted at Beijing Tongren Eye Center, China. Outcome measures were compared between 3 groups: successful and complete (≥330 degrees) MAT; successful and partial (<330 degrees) MAT; or cases converted to traditional trabeculotomy when the Schlemm's canal could not be catheterized >180 degrees. Success was defined as final intraocular pressure ≤21 mm Hg, with (qualified success) or without (complete success) glaucoma medications.

RESULTS

In total, 74 eyes of 63 consecutive patients were included. MAT was performed in 50 eyes (67.6%). Postoperative intraocular pressure and number of glaucoma drops (17.7±8.6 mm Hg, 0.6±1.2 medications) was significantly less than the preoperative values (35.3±7.2 mm Hg, 2.7±0.8 medications; P<0.001). Cumulative probabilities of qualified and complete success were 84.0% and 80.0% at 3-year follow-up with no difference between complete and partial trabeculotomies. MAT was not successfully performed in 24 eyes (32.4%), requiring conversion to traditional trabeculotomy and associated with greater incidence of previous surgeries (P<0.001), earlier age of disease onset (P=0.024) and worse corneal transparency (P=0.010). Cumulative probabilities of qualified and complete success were 37.0% and 29.2% at 3-year follow-up.

CONCLUSIONS

Both complete and partial MAT achieved significant pressure reduction in cases of primary congenital glaucoma with previous failed glaucoma surgeries in intermediate term.

Childhood glaucoma profile in Dakahelia, Egypt: a retrospective study

AIM

To analyze childhood glaucoma regarding its demographics, presentations, different causes and surgical modalities used among patients in Dakahelia and to apply the Childhood Glaucoma Research Network (CGRN) classification retrospectively to evaluate its convenience.

METHODS

A retrospective study in which the medical files of all glaucoma patients <16 years old presented to Mansoura Ophthalmic Center, Mansoura University from 2014 to 2017, were retrieved and analyzed. Collected data included: age, gender, laterality, visual acuity (VA), refraction, intraocular pressure (IOP), corneal diameter, cup-disc ratio, types and number of surgeries and antiglaucomatous drugs (AGD) at the first and last visit. Prevalence of different subtypes was calculated and means of clinical features were compared.

RESULTS

A total of 305 eyes of 207 patients were included classified into 6 groups: primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), glaucoma associated with systemic disease, glaucoma associated with ocular anomalies, acquired glaucoma and glaucoma following cataract surgery. PCG was the predominant type (55.1%) followed by acquired glaucoma (29.5%). Males represented 63.8% of the whole studied patients. Glaucoma associated with ocular anomaly group showed the youngest age at diagnosis (21.9±30.0mo). The shortest corneal diameter was recorded in post cataract group (10.4±0.5 mm). Highest cup-disc ratio was found in the PCG group (P<0.0005). Glaucoma associated with systemic disease presented with the highest baseline IOP (34.5±5.0 mm Hg). All the cases with PCG were treated surgically with 21.8% required more than one surgery. The majority of the patients (74.2%) in the acquired group were treated medically. Combined trabeculotomy-trabeculectomy was the most frequent operation done, accounting for 34.5% of all primary surgeries. Ahmed valve implantation comprised 87% of the secondary surgeries. Acquired glaucoma group had the highest percent of eyes with good final Snellen's VA (69.4%), while glaucoma associated with ocular anomaly group had poorest final VA.

CONCLUSION

PCG is the most prevalent type of childhood glaucoma, followed by acquired glaucoma especially traumatic hyphema. Combined trabeculotomy-trabeculectomy and Ahmed valve implantation are the most common surgical interventions. CGRN classification is found to provide a consensus skeleton and is recommended to be integrated in our routine ongoing clinical practice.

The Economic Burden of Childhood Glaucoma

PURPOSE

To date, there are limited data on the economic burden of childhood glaucoma, a relatively rare but visually debilitating disease. The purpose of this study is to evaluate the immediate costs of illness associated with childhood glaucoma during the first 4 years after presentation.

METHODS

Data on age, sex, surgical interventions, visits, examinations under anesthesia, and medications were collected yearly following presentation in patients with childhood glaucoma. Inclusion criteria included diagnosis of primary or secondary childhood glaucoma, age less than 21 years, and follow-up of 4 years. A total of 23 patients (39 eyes) were included. Cost analysis used 2013 hospital-specific charges and US average hourly wage to calculate outcomes of total, direct, and indirect costs (significance level P<0.05).

RESULTS

The annual cost of care of childhood glaucoma averaged $21,441.61 per patient, representing 1100% of annual costs in adult glaucoma and an increase of 800% in annual costs of health care per pediatric patient. The average total 4-year cost of care was $85,074.96 per patient. Surgical interventions and examinations under anesthesia were the greatest contributors to costs, representing 69.0% and 23.2% of total 4-year costs, respectively. The annual costs of care for childhood glaucoma were highest in the first year compared with subsequent years, averaging $46,293.62 per patient (P<0.05).

CONCLUSIONS

Childhood glaucoma carries a substantial economic burden with the highest costs occurring in the first year after presentation. The greatest contributors to cost of illness are surgical interventions and examinations and anesthesia.

Viscocanalostomy combined with trabeculotomy and mitomycin C in the treatment of primary congenital glaucoma

AIM

To evaluate the long-term outcome of viscocanalostomy combined with trabeculotomy and mitomycin C in the treatment of primary congenital glaucoma.

METHODS

This is a retrospective study. Forty-two eyes of 26 patients with primary congenital glaucoma were enrolled. Intraocular pressure (IOP), corneal diameter (mm) and cup/disc (C/D) were measured before and after the surgery respectively. Follow-up period was 30mo.

RESULTS

The mean preoperative IOP was 30.6±7.35 mm Hg. Of the 42 eyes, 2 eyes were required conversion to trabeculectomy for the absence of Schlemm's canal. Of remained 40 eyes, 38 eyes (95%) achieved successful IOP control. The average postoperative IOP was 11.69±4.18 mm Hg at 12mo. The mean reduction was 18.91 mm Hg (P<0.0001). Eighteen (75%) eyes presented a reduction in corneal diameter, and 25 (62.5%) eyes presented a C/D ratio reversal after the surgery. There was no serious complication in any patients over the follow-up period.

CONCLUSION

Viscocanalostomy combined with trabeculotomy and mitomycin C is useful in the management of primary congenital glaucoma.

Résultats pressionnels et visuels à long terme de la sclérectomie profonde dans le glaucome congénital primitif

OBJECTIVE

To estimate long term future of pressure and vision of children who underwent DS for CPG.

MATERIAL AND METHODS

Children affected by CPG, aged from 1 day to 3 years at the time of the diagnosis were retrospectively included between 1999 and 2014. All benefited from a DS with use of antimetabolites. Preoperative and long-term post-operative intraocular pressures (IOP), per and postoperative complications as well as visual acuity and refractive status were estimated. Complete IOP control was defined by a postoperative IOP ≤16 mmHg without medical treatment.

RESULTS

141 eyes of 71 children were included (sex ratio: 1.02). Mean follow-up was 56.6 ±9.6 months. Final average IOP among the whole sample was 11.3 +/-7 mmHg. The rate of total success was 69.4 %, partial success 27.6 % and 3 % failure at the last check. No complications were seen in 85.1 % of cases (n=120 eyes). Among 37 children analyzed for visual acuity, maintained visual acuity was found in 50 % of cases (n= 37 eyes).

CONCLUSION

DS allows obtaining good IOP control with a very low rate of complications, and should be considered as a technique of choice in the surgical management of CPG. This study is of particular relevance because it has been led on a long term period and on an important staff considering the rare prevalence of the condition.

Combined vitrectomy and glaucoma drainage device implantation surgical approach for complex pediatric glaucomas

PURPOSE

To evaluate efficacy of combined vitrectomy with posteriorly placed glaucoma drainage device (GDD) in lowering intraocular pressure (IOP) in children.

METHODS

The medical records of children who underwent vitrectomy with posteriorly placed GDD were reviewed retrospectively. Patients with a minimum of 6 months' follow-up were included. The first eye operated on for each patient was analyzed. Success was defined as IOP of 5-20 mm Hg and no additional IOP-lowering surgery or visually devastating complications.

RESULTS

A total of 20 patients were included, with the following etiologies: primary infantile-onset glaucoma, 5 (25%); traumatic glaucoma, 3 (15%); Peters anomaly, 3 (15%); microphthalmia, 5 (25%); glaucoma following cataract surgery, 2 (10%); microspherophakia, 1 (5%); and retinopathy of prematurity, 1 (5%). Eyes with corneal opacification (8 [40%]) underwent endoscopic vitrectomy (5 [25%]), concurrent penetrating keratoplasty (3 [15%]) and/or keratoprosthesis surgery (1 [5%]). Mean follow-up was 1.9 ± 1.1 years (range, 6.5-49.2 months). Vision remained stable or improved in 17 eyes (85%). Mean IOP decreased from 27.2 ± 10.1 mm Hg to 14.5 ± 6.8 mm Hg (P < 0.0001) at last follow-up or at failure. Kaplan-Meier curves showed 12- and 24-month rate of IOP control of 69% and 62%, respectively. The number of glaucoma medications decreased from a mean of 2.3 ± 1.4 to 1.3 ± 1.2 (P < 0.015) at last follow-up or at failure. Overall success rate was 65%. Complications included hypotony (3 [15%]), vitreous hemorrhage (1 [5%]), and retinal detachment (1 [5%]). Two eyes (10%) required surgery for hypotony; 4 eyes (20%) underwent additional glaucoma surgery.

CONCLUSIONS

Combined surgical approach with vitrectomy and posteriorly placed GDD decreased IOP in complex pediatric glaucomas. Further, endoscope-assisted vitrectomy is useful in cases with corneal opacification. Complication rates of this combined procedure appear to be comparable to traditional anterior chamber approach.

Modified goniotomy as an alternative to trabectome in primary open angle glaucoma and pseudoexfoliation glaucoma: 1 year results

OBJECTIVE

To assess the outcome of modified goniotomy and trabeculotomy ab interno (Trabectome) surgery in adult primary open-angle glaucoma (POAG) and pseudoexfoliation (PEX) glaucoma.

DESIGN

Retrospective cohort outcome study.

PARTICIPANTS

Two hundred and thirty-six eyes of 236 patients.

METHODS

This cohort outcome study included 68 POAG (mean age: 65.7 ± 16.0 years) and 22 PEX glaucoma patients (mean age: 78.3 ± 7.9 years) in the modified goniotomy cohort and 119 POAG (mean age: 73.9 ± 9.6 years) and 27 PEX glaucoma patients (mean age: 75.2 ± 8.0 years) in the Trabectome cohort. Modified goniotomy is defined as combined ab interno cyclodialysis and goniotomy. The patients were followed up for 12 months, and we analysed the data using SPSS v19.0.

RESULTS

In POAG, the intraocular pressure (IOP) was significantly reduced by 4.6 mm Hg in the Trabectome cohort (p < 0.001) and by 5.8 mm Hg (p < 0.001) in the goniotomy group at 1-year follow-up. In PEX glaucoma, the mean IOP was reduced by 9.7 mm Hg (p = 0.002) in the Trabectome surgery and by 6.7 mm Hg (p = 0.004) in the goniotomy cohort 1 year later. Comparing both surgery techniques in POAG, no significant correlation was found in terms of IOP at any of the follow-up visits (IOP at 1 year, p = 0.553). In PEX glaucoma, the IOP, visual acuity, and number of glaucoma medications did not differ significantly between the 2 surgery techniques 1 year later (IOP: p = 0.300; VA: p = 0.391; therapy: p = 0.908).

CONCLUSION

Modified goniotomy and Trabectome surgery are reliable and effective tools for the management of moderate POAG and PEX glaucoma. There was no significant difference in IOP between the 2 procedures over a follow-up period of 1 year.

Outcomes of microcatheter-assisted trabeculotomy following failed angle surgeries in primary congenital glaucoma

PurposeTo report surgical outcomes of microcatheter-assisted trabeculotomy following failed angle surgeries, and compare those with no previous angle surgery, in primary congenital glaucoma (PCG).MethodsThe early postoperative (12 months) results of 42 eyes of 36 patients who underwent microcatheter-assisted trabeculotomy by single surgeon for PCG were retrospectively analyzed. Group 1, 20 eyes of 16 patients, had no previous angle surgery. Group 2, 22 eyes of 20 patients, had one or two previous failed angle surgeries. Success was defined as an intraocular pressure (IOP) <21 mm Hg with at least a 30% reduction from preoperative IOP with (qualified success) or without (complete success) the use of antiglaucoma medication.ResultsMean IOP decreased from 31.5±7.2 mm Hg on 3 (median, range: 1-5) medications in Group 1 and 34.6±7.3 mm Hg on 3 (median, range: 1-4) medications in Group 2 preoperatively to 15.6±3.1 mm Hg on 0 (median, range: 0-4) medications in Group 1 and 16.0±4.6 mm Hg on 0 (median, range: 0-2) medications in Group 2 postoperatively at 12 months (both P<0.001), respectively. The mean percentage of IOP reduction from preoperative to last postoperative visit was 46.0±20.1% in Group 1 and 45.5±25.0% in Group 2, P=0.947. Qualified and complete successes were comparable between Group 1 and Group 2 (qualified success: 90.0% vs 77.3%, P=0.294; complete success: 78.9% vs 77.3%, P=0.853). Complications were minimal.ConclusionsMicrocatheter-assisted trabeculotomy achieved significant pressure-lowering effects with a reduction in medication use in PCG, and it represents a reasonable choice of initial and repeat surgical treatment for PCG.

Latanoprost and Dorzolamide for the Treatment of Pediatric Glaucoma: The Glaucoma Italian Pediatric Study (Gipsy), Design and Baseline Characteristics

Introduction

To investigate the efficacy of a treatment strategy with latanoprost and dorzolamide in primary pediatric glaucoma patients partially responsive to surgery.

Methods

Single arm, prospective, interventional multicenter study. Primary pediatric glaucoma patients younger than 13 years after a single surgical procedure with IOP between 22 and 26 mmHg were considered eligible. At baseline, patients were allocated to latanoprost monotherapy once daily. Depending on intraocular pressure (IOP) reduction at first visit, the patients were allocated to one of three groups: continuation of latanoprost monotherapy, addition of dorzolamide twice daily, or switch to dorzolamide three times daily. The same approach for allocation in medication groups was used in all subsequent visits. Patients in the dorzolamide monotherapy group with IOP reduction <20% from baseline were considered non-responders and withdrawn. Study treatment and patient follow-up will continue for 3 years or until treatment failure. The primary endpoint is the percentage of responders. Secondary endpoints are time to treatment failure and frequency of adverse events.

Results

A total of 37 patients (69 eyes) were enrolled. The mean age was 4.0 ± 3.8 years, the female/male ratio was 1/1.7, and the majority of patients were Caucasian. Eighty percent of patients had bilateral glaucoma. Goniotomy was the most frequently performed surgery (38.6%), followed by trabeculotomy (22.8%), trabeculectomy (21.1%), and trabeculectomy plus trabeculotomy (17.5%). The baseline IOP was 23.6 ± 1.5 mmHg.

Conclusion

The study population is representative of patients frequently encountered after the first surgery for primary pediatric glaucoma. The study will produce evidence on the medium-term efficacy of a defined pharmacological approach.

Aqueous Humor Outflow Structure and Function Imaging At the Bench and Bedside: A Review

Anterior segment glaucoma clinical care and research has recently gained new focus because of novel imaging modalities and the advent of angle-based surgical treatments. Traditional investigation drawn to the trabecular meshwork now emphasizes the entire conventional aqueous humor outflow (AHO) pathway from the anterior chamber to the episcleral vein. AHO investigation can be divided into structural and functional assessments using different methods. The historical basis for studying the anterior segment of the eye and AHO in glaucoma is discussed. Structural studies of AHO are reviewed and include traditional pathological approaches to modern tools such as multi-model two-photon microscopy and optical coherence tomography. Functional assessment focuses on visualizing AHO itself through a variety of non-real-time and real-time techniques such as aqueous angiography. Implications of distal outflow resistance and segmental AHO are discussed with an emphasis on melding bench-side research to viable clinical applications. Through the development of an improved structure: function relationship for AHO in the anterior segment of the normal and diseased eye, a better understanding of the eye with improved therapeutics may be developed.

Fiberoptic Microcatheter-assisted 360-Degree Trabeculotomy Ab Externo After Unsuccessful Trabeculotome Trabeculotomy in Primary Congenital Glaucoma: A Case Report

Fiberoptic microcatheter-assisted 360-degree trabeculotomy ab externo is a recent technique. Retrospective studies have proved the effectiveness as a first-angle surgery in eyes with primary congenital glaucoma. However, there are no reports in which it is performed after another unsuccessful surgical procedure. We present our case of a monolateral congenital glaucoma. We first performed an ab externo trabeculotomy with poor control of intraocular pressure (IOP). Then, a microcatheter-assisted 360-degree trabeculotomy was performed with IOP lowering. Microcatheter-assisted 360-degree trabeculotomy supplies successful IOP lowering after another angle surgery procedure.

Acute Corneal Hydrops in Children with Primary Infantile Glaucoma: A Report of 31 Cases over 23 Years at the LVPEI

Purpose

Relatively little data exist regarding the outcomes of children with primary infantile glaucoma presenting with acute corneal hydrops. The aim of our study was to determine the surgical outcome of children of infantile glaucoma who presented with acute corneal hydrops.

Methods

In total, 38 eyes of 31 consecutive children of infantile glaucoma presented with acute corneal hydrops who underwent primary combined trabeculotomy-trabeculectomy (CTT) by a single surgeon from January 1990 to December 2012 at the LV Prasad Eye Institute (LVPEI), a tertiary eye care centre in Southern India were enrolled in this retrospective study. Primary outcome measures were intraocular pressure (IOP) control (IOP ≤ 16 mmHg under anaesthesia or IOP ≤ 21 mmHg without anaesthesia) and clearance of corneal edema. Secondary outcome measures were visual acuity (VA), corneal diameter, bleb appearance, intraoperative and postoperative complications.

Results

Mean age at presentation was 6.4 months (range, 2–11 months) and seven eyes (23%) had bilateral affliction. At presentation, all eyes (100%) had moderate to severe degree of corneal edema with a mean preoperative IOP of 25.6 ±5.1 mmHg. Postoperatively, the IOP reduced to 12.0 ± 3.8 mmHg (difference = -13.6, 95% CI = -15.7 to -11.5, t = -13.18, p<0.0001), and the percentage reduction in IOP was 53.05%. Preoperatively 83% of the eyes were on antiglaucoma medication, and postoperatively 2 eyes (5.3%) required 1 antiglaucoma medication for control of IOP. Preoperatively, corneal edema was present in all eyes and postoperatively it cleared in all of them. Significant myopic astigmatism was present in 28 eyes (74%), the commonest being compound myopic astigmatism (75%) followed by simple myopic astigmatism (21%). Normal VA (best-corrected VA; BCVA ≥ 20/60) was achieved in 44.4% of the eyes and 22.2% eyes had low vision (BCVA, <20/60 to 20/400). Complete success (IOP control and clearance of corneal oedema) was obtained in 94.7% eyes. There were no significant intraoperative or postoperative complications. Two thirds of the patients showed low, elevated functional filtering bleb. No patient had any bleb leak, blebitis or bleb related endophthalmitis. The median follow-up was 36 months (range 2–228 months).

Conclusions

Primary CTT is safe and effective in controlling IOP, resulting in complete clearance of corneal edema with modest visual improvement in children of infantile glaucoma presenting with acute corneal hydrops. The outcome of the study will have a positive impact on counseling the parents preoperatively.

Therapeutic effect analysis on the treatment of congenital glaucoma through modified combined trabeculotomy-trabeculectomy

AIM

To evaluate the therapeutic effect and the safety of the treatment of congenital glaucoma through modified combined trabeculotomy-trabeculectomy.

METHODS

The clinical data of 27 cases (altogether 42 eyes), which included 7 cases of infants (10 eyes) and 20 cases of teenagers (32 eyes), of congenital glaucoma undertook modified combined trabeculotomy-trabeculectomy were analyzed retrospectively. The parameters evaluated included the post operation visual acuity, the anterior chamber, the filtering bleb, the intraocular pressure, the C/D ratio, visual field, the retinal nerve fiber layer changes and the complications.

RESULTS

The follow-up period was 1 to 29mo, averaging 13.3±7.7mo. Upon the last visit after the operation, functional filtering blebs developed in all the involved eyes. The intraocular pressure was controlled under 21 mm Hg, which was decreased by 60% when compared with that before the operation, without using any medication. There were no significant changes in the post operation visual acuity and the retinal nerve fiber layer thickness before and after the operation in teenager group (P>0.05), and both the post operation C/D ratio and the visual field mean defect (MD) were reduced compared with those before the operation (P<0.05). There were no severe complications in any of the patients.

CONCLUSION

The modified combined trabeculotomy-trabeculectomy can effectively reduce the intraocular pressure and control the development of glaucoma in cases of congenital glaucoma. It is a safe and effective operative method for the treatment of congenital glaucoma.

Characteristics of Children With Primary Congenital Glaucoma Receiving Trabeculotomy and Goniotomy

PURPOSE

To describe the groups of patients who received trabeculotomy or goniotomy for the treatment of primary congenital glaucoma (PCG) regarding age at treatment, intraocular pressure (IOP) outcome, and medication burden.

METHODS

A retrospective chart review of patients with PCG seen at Rutgers New Jersey Medical School, Newark, New Jersey, from 1998 to 2012 was conducted. Inclusion criteria were patients who received trabeculotomy or goniotomy with at least 9 months of follow-up. Presenting examination, surgical intervention, IOP, and number of medications at 1 and 2 years postoperatively were recorded. Absolute and qualified success, defined as IOP greater than 5 and less than 21 mm Hg without and with medications, respectively, was determined.

RESULTS

Fifty eyes of 29 patients were diagnosed as having PCG. Of those, 25 eyes received trabeculotomy or goniotomy, with 19 fulfilling inclusion criteria. Average age at the time of trabeculotomy was 8 months versus 21 months for patients undergoing goniotomy. Mean IOP was significantly reduced (P < .001) for both trabeculotomy and goniotomy by 29.5% at 1 year and 33.3% at 2 years. There was no significant difference in IOP control between trabeculotomy and goniotomy groups. Patients in the goniotomy group were treated with significantly more medications before and after surgery compared to patients receiving trabeculotomy (P < .01), resulting in a greater rate of absolute success in trabeculotomy at 1 and 2 years.

CONCLUSIONS

Patients with PCG who underwent trabeculotomy had higher IOP and were treated at an earlier age than those who had goniotomy. Both effectively lowered IOP up to 2 years with greater medication burden in patients receiving goniotomy.

Newborn Glaucoma with Imperforate Pupil

PURPOSE

This case report describes the surgical technique of trabeculectomy, mechanical separation of the iris from the cornea, and creation of a pupillary aperture by an automated vitrector in a child with newborn glaucoma with imperforate pupil.

CASE REPORT

A 1-month-old child was referred to us with the diagnosis of congenital glaucoma of the left eye. Examination under anesthesia revealed megalocornea (corneal diameter, 12 mm) with corneal edema of the left eye whereas the right eye was normal. Intraocular pressure was 8 and 26 mm Hg in the right eye and left eye, respectively. Examination under anesthesia revealed imperforate pupil with uveal tissue attached on the back surface of the left cornea whereas the iris and the pupil of the right eye were normal. A diagnosis of newborn glaucoma and imperforate pupil of the left eye was made and the child underwent trabeculectomy, mechanical separation of the iris from the back surface of the cornea, and creation of pupillary aperture by an automated vitrector. The child had an uneventful postoperative course with disappearance of corneal edema, but there were several linear scars across the cornea. The child completed 3 years of follow-up and his best spectacle corrected visual acuity in the left eye was 20/32 and the intraocular pressure was 10 mm Hg in both eyes.

CONCLUSIONS

The surgical technique was safe and effective in the restoration of corneal clarity and creation of the pupillary aperture with good visual recovery.

[Glaucoma surgery in children]

BACKGROUND

Goniotomy has been established as the standard procedure in the treatment of congenital glaucoma for more than 50 years.

OBJECTIVES

This article presents the current indications for the different antiglaucomatous procedures in children with success rates and specific complications.

METHODS

A selective literature search was carried out and a report of the consensus meeting 2013 concerning congenital glaucoma and personal experiences are presented.

RESULTS

Primary surgical treatment for primary congenital glaucoma mainly consists of trabeculotomy and its modifications but also of goniotomy. A widespread and increasing use of drainage device surgery can be seen in complicated types of pediatric glaucoma, such as secondary glaucoma due to aphakia, uveitis or Sturge-Weber-Krabbe syndrome.

CONCLUSION

The visual prognosis following glaucoma surgery generally depends on successful control of the intraocular pressure as well as on amblyopia treatment.