REVIEW – March 2014

Glaucoma in children

Authors: Pille Tein

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Glaucoma in children is a rare condition. There are many causes of elevated intraocular pressure (IOP), from anatomic defects and genetic syndromes to neoplastic and infectious processes, that can include glaucoma. A careful history and examination of the child are important to diagnoose childhood glaucoma. The most accurate measurements can be obtained during examination under anaesthesia.

Pediatric glaucoma often requires a combination of medications and surgery for optimal IOP control. The management of childhood glaucoma is primarily surgical with the goal of permanently controlling IOP. The choice of surgical procedures is individualized according to factors such as the visual potential of the eye. Medical therapy is frequently needed as temporizing IOP-lowering treatment before surgery or as adjuvant therapy after partially successful surgical procedures in childhood glaucoma. Both surgical procedures, goniotomy and trabeculotomy, through incising the angle tissue, aim to eliminate obstruction to aqueous outflow. Trabeculectomy has several postoperative complications. Deep sclerectomy is used to reduce postoperative complications. A combination of deep sclerectomy with trabeculotomy is effective and provides reasonable control of IOP with few postoperative complications.