Minimally Invasive Glaucoma Surgery

Unlike adult glaucoma, the treatment of primary and some of the secondary childhood glaucoma is primarily surgical. This heterogeneous group of disorders, characterized by elevated intraocular pressure (IOP) and characteristic glaucomatous optic neuropathy, are all rapidly progressive and do not respond well to conservative medical management. Conventionally, angle-based surgeries (goniotomy and trabeculotomy) are the primary choices for managing childhood glaucoma, while trabeculectomy and glaucoma drainage devices are typically reserved for refractory cases. Cyclophotocoagulation is usually considered a last resort when IOP remain uncontrolled despite maximal medical therapy and surgical management. The concept of minimally invasive glaucoma surgeries (MIGS) as conjunctival sparing procedures is appealing to pediatric glaucoma specialists. However, there is limited evidence in the literature regarding their efficacy and safety in childhood glaucoma.