Pediatric Glaucoma: Trabeculectomy and Glaucoma Drainage Devices

Abstract

Usually the answer is no. Many goniotomy/trabeculotomy failures occur in the first several months after the procedure [8]. Both severity of presentation and age at presentation have been correlated with treatment success in primary congenital glaucoma, with birth-onset, late-onset, and more severe presentations (large corneal diameter and high intraocular pressure (IOP)) correlating negatively with successful glaucoma control [1, 8]. Both goniotomy and trabeculotomy surgery can be repeated (goniotomy up to three procedures) [8]. If repeat angle surgery along with resumption of medical therapy is not successful during infancy, trabeculectomy with adjunctive mitomycin offers a low chance of success [3, 4, 11]. The one exception is the older, phakic school age child for whom mitomycin trabeculectomy has a good chance of success, albeit with a life-long risk of bleb-related endophthalmitis [4, 11, 25]. In contradistinction to trabeculectomy, tube-shunt surgery offers a reasonable chance of success for glaucoma that has failed angle surgery treatment during the infantile and pre-school periods [3, 5]. The risk of endophthalmitis is low with tube-shunt procedures and generally occurs only if the tube or implant becomes exposed [12]. Revision of GDD procedures is more common in very young children due to the higher occurrence of tube-cornea touch and retraction of the tube out of the anterior chamber. However, successful control of the glau­coma can be maintained despite revision of tube-shunt devices [3].