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Eye (2007) 21, 13191325 & 2007 Nature Publishing Group All rights reserved 0950-222X/07 $30.00
www.nature.com/eye
Advances in the management of paediatric glaucoma
CAMBRIDGE
OPHTHALMOLOGY
SYMPOSIUM
M Papadopoulos1 and PT Khaw2
Abstract
The paediatric glaucomas present some of the greatest clinical challenges. We review the advances in the management of the paediatric glaucomas, which have improved the outlook for these patients and their families. These advances include improvements in diagnosis, investigations, anaesthetic techniques, medical, surgical, and laser therapies. Eye (2007) 21, 13191325; doi:10.1038/sj.eye.6702850
Keywords: paediatric glaucoma; goniotomy; trabeculotomy; trabeculectomy; tube surgery
Introduction
Paediatric glaucoma is a relatively rare, potentially blinding condition caused by elevated intraocular pressure (IOP). It is classied into primary, where there is a developmental anomaly of the angle alone, and secondary, where outow obstruction is due to an ocular or systemic condition.1 Primary congenital glaucoma (PCG) due to isolated trabeculodysgenesis is the commonest glaucoma seen in infancy.2,3 Conditions commonly causing secondary glaucoma include AxenfeldReiger Anomaly, Peters Anomaly, uveitis, aphakia, aniridia, and SturgeWeber syndrome.
The management of children with glaucoma presents the ophthalmologist with some of the most anxious but at the same time incredibly rewarding periods in clinical practice. It is so challenging that most cases are managed in tertiary institutions.4 The goal of preserving a lifetime of vision for these children involves early, prompt control of IOP, correction of ametropia and rigorous amblyopia treatment. The control of IOP in PCG is primarily surgical with medical therapy playing a supportive role, whereas in secondary glaucomas, medical therapy is rst line except in congenital cases where surgery is often required to control IOP.
Untreated or suboptimally treated the outcome of paediatric glaucoma is known to be poor.5,6 However, over the last 60 years, there has been a dramatic improvement in the prognosis of this disease following the introduction of new surgical techniques and the recognition of amblyopia as an important cause of poor vision. The introduction of angle surgery revolutionised the prognosis of PCG. Goniotomy was rst reported in children in 1942 by Barkan,7 followed by trabeculotomy in the 1960s independently described by both Smith8,9 and Burian10,11 and popularised by Harms and Dannheim.12 Subsequently, techniques widely used in adults such as trabeculectomy and drainage implant surgery have increasingly played a role in refractory cases...