Non-penetrating Glaucoma Surgery

Childhood glaucoma is one of the most challenging types of glaucoma to manage. Non-penetrating glaucoma surgery (NPGS) has been suggested as a good surgical option based on its high safety profile and lower incidence of intraoperative and postoperative complications. The technique depends on properly exposing a trabeculo-Descemet window that allows aqueous percolation without globe penetration. Identifying surgical landmarks and meticulous surgical techniques are crucial for good outcomes, with peculiar surgical considerations in the pediatric age group. Numerous surgical modifications were attempted to facilitate the surgical technique, including the recent development of carbon dioxide-assisted deep sclerectomy surgery (CLASS). Non-penetrating glaucoma surgery can also be combined with other procedures, such as trabeculotomy, to improve efficacy. This chapter will explore the various aspects of pediatric NPGS, encompassing surgical anatomy, techniques, modifications, complications, and literature-reported outcomes across different types of childhood glaucomas.