Current surgical options for the management of pediatric glaucoma

Jose Morales, Sami Al Shahwan, Sami Al Odhayb, Ibrahim Al Jadaan, Deepak P Edward, Jose Morales, Sami Al Shahwan, Sami Al Odhayb, Ibrahim Al Jadaan, Deepak P Edward

Abstract

Currently, there are numerous choices for the treatment of pediatric glaucoma depending on the type of glaucoma, the age of the patient, and other particularities of the condition discussed in this review. Traditionally, goniotomy and trabeculotomy ab externo have been the preferred choices of treatment for congenital glaucoma, and a variety of adult procedures adapted to children have been utilized for other types of pediatric glaucoma with variable results and complications. More recently, seton implantations of different types have become more popular to use in children, and newer techniques have become available including visualized cannulation and opening of Schlemm's canal, deep sclerectomy, trabectome, and milder more directed cyclodestructive procedures such as endolaser and transcleral diode laser cyclophotocoagulation. This paper reviews the different surgical techniques currently available, their indications, results, and most common complications to allow the surgeon treating these conditions to make a more informed choice in each particular case. Although the outcome of surgical treatment in pediatric glaucoma has improved significantly, its treatment remains challenging.

Figures

Figure 1
Figure 1
Ritch direct panoramic gonioscopy lens.
Figure 2
Figure 2
Eye from patient with pediatric glaucoma with two glaucoma drainage implants.
Figure 3
Figure 3
Eye of patient with extruded tube.
Figure 4
Figure 4
Transcleral diode laser cyclophotocoagulation being performed in a child with congenital glaucoma refractive to other treatments. Transillumination probe being utilized to aid in the correct localization of ciliary body.
Figure 5
Figure 5
Scleral thinning spots after transcleral diode laser cyclophotocoagulation in pediatric patient.
Figure 6
Figure 6
360 degree trabeculotomy in a newborn child. Illuminated catheter progressing around Schlemm's canal at 12 o'clock evidenced by red light.
Figure 7
Figure 7
Deep sclerectomy performed in a a child with glaucoma secondary to Sturge-Weber Syndrome.

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Source: PubMed

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