Childhood glaucoma surgery

It involves encouraging the drainage of intraocular liquid (aqueous humour), since high intraocular pressure is the most common cause associated with the onset of glaucomatous damage.

You must bear in mind that childhood glaucoma treatment is mainly surgery. Medical treatment is reserved to cases that are not fully developed and/or as preparation prior to short-term surgery.

There are different techniques:

• Angle closue surgery: goniotomy, trabeculotomy, canaloplasty.
• Filtration surgery: trabeculectomy, trabeculostomy, non perforating surgery.
• Drainage mechanisms (tubes): the most commonly used are the Ahmed valve and the non-valved Baerveldt valve.
• Cyclodestructive procedures: conventional laser diode and MP3 probe. 
• MIGS (Minimally Invasive Glaucoma Surgery).

The use of each of these techniques will depend on the type of glaucoma, the age of onset, and the characteristics of the eye (particularly the condition of the cornea, the existence (or lack thereof) of eye pathologies. 

Any surgical technique used on children must be performed under general anaesthesia. 

The results depend on each of the different techniques applied, as well as the characteristics of the eye and the age of the children at the time of the diagnosis. 

Angular surgery (goniotomy, trabeculectomy, canaloplasty) must be performed, if possible, as a matter of principle and, filtration surgery (trabeculectomy and trabeculostomy) must be reserved to cases where the condition of the cornea prohibits it, or when angular surgery has proven insufficient for the evolutionary control of glaucoma.  

The rate of success of goniotomy and trabeculectomy is 75-90%. The technique used in filtration surgery has a lower rate of sucess because of high healing tendency of children, which means the technique may be less effective over the short and long term. Drainage mechanisms usually have a high rate of success, but they are not exempt from preoperative complications attributable to possible eye decompression.

The child's eyeball has special anatomical and histological characteristics that condition the outcome, which means it is fundamental that the technique modifications are made to the technique compared to the technique applied to adults.