Trabeculectomy

Most children with glaucoma will require surgical intervention in their lifetime, often during their early childhood years. Childhood glaucoma surgery presents unique challenges due to differences in anatomy, tissue response to surgical trauma, and the difficulty in post-operative monitoring and management compared to adults, leading to a greater potential for failure and complications. While goniotomy and trabeculotomy can be useful in mild to moderately severe glaucoma cases, advanced cases require trabeculectomy or combined trabeculotomy with trabeculectomy for adequate intraocular pressure control. Antifibrotic adjuncts such as mitomycin C can be used to improve surgical success rate; however, their use carries an increased risk of bleb thinning and blebitis. This chapter aims to discuss various techniques and simple modifications of trabeculectomy to enhance its effectiveness and safety in children with glaucoma.