Paediatric Glaucoma

Childhood glaucoma is a rare and potentially blinding disease. Treatment for childhood glaucoma is challenging. Early diagnosis and appropriate IOP control  are very important for visual prognosis. Treatment can be performed from medication to surgery. Glaucoma surgery is the treatment of choice. Surgical goniotomy , trabeculectomy , trabeculotomy , combined trabeculotomy and trabeculectomy(CTT) , glaucoma drainage device(GDD) implant are chosen depend on severity of the disease. In primary congenital glaucoma, treatment of choice is primary surgical goniotomy or trabeculotomy. Each procedure has success rate of 40-90%.

For refractory cases, CTT or GDD may be considered. Indication for CTT includes poor prognostic factor for angle surgery such as newborn glaucoma, older age (> 2 years old) and secondary glaucoma. Moreover, CTT can be used in corneal opacity precluding view of angle.

GDD may be an option for patients who had angle surgery failure, glaucoma after cataract surgery and Sturge-weber syndrome (SWS). GDD may decrease risk of hypotony in SWS when compared to CTT. Tube related complications include tube migration, erosion, and infection.

According to prospective, randomized comparative study in advanced congenital glaucoma who underwent CTT and GDD, GDD has better long term survival.

In conclusion, Childhood glaucoma is a sight threatening disease. Early detection and proper management are challenging and rewarding for this blinding disease.

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