Decision-Making in Pediatric Glaucoma Surgery

Childhood or pediatric glaucoma is a group of ocular disorders that primarily affect the optic nerve in the presence of elevated intraocular pressure. Progressive optic neuropathy with progressive vision loss is the natural course and eventual outcome of this condition. However, in the pediatric population, the vision can also be affected via deprivational (e.g., corneal opacities) or refractive amblyopia (high myopia, anisometropia, etc.), which is why a comprehensive assessment and approach is a key in preserving vision. Pediatric glaucoma can be classified according to the age of onset into congenital or infantile glaucoma, according to the etiology into primary or secondary glaucoma, and according to the anatomical status of the anterior chamber angle into open-angle or angle-closure glaucoma. The most common subtype is primary congenital glaucoma (PCG). Many types of pediatric glaucoma have complex nuances with equally complex management processes. A timely approach to treating pediatric glaucoma, particularly PCG, is critical, and delay in management carries a high risk of visual morbidity and consequent social and economic burden. In this chapter, we aim to outline the systematic approach to managing pediatric glaucoma, surgical planning, and interim temporizing measures.