Our Summary

This research paper discusses the challenges of performing glaucoma surgery on children. This is due to differences in their eye anatomy compared to adults, varying disease causes, and difficulties with after-surgery care. Two treatments, Goniotomy and Trabeculotomy, are usually the first options for primary congenital glaucoma. Another procedure, Trabeculectomy with added Mitomycin C, is more successful in older children with their natural lens, but it comes with a long-term risk of a serious eye infection. Glaucoma drainage devices could be a better option for younger children and those with a specific type of glaucoma, but these devices can also lead to complications. Finally, procedures that destroy the ciliary body (cyclodestructive procedures) are used as a last resort in cases where other surgeries have failed due to their unpredictable results and potential for serious side effects.

FAQs

  1. What are the preferred initial treatments for primary congenital glaucoma in children?
  2. What are the potential risks and complications associated with different types of pediatric glaucoma surgeries?
  3. When are cyclodestructive procedures considered for children with glaucoma?

Doctor’s Tip

A helpful tip a doctor might tell a patient about glaucoma surgery is to follow the postoperative instructions carefully, including taking any prescribed medications as directed, attending follow-up appointments, and avoiding activities that could put pressure on the eyes. It is important to communicate any changes or concerns with the doctor to ensure the best possible outcome from the surgery.

Suitable For

Patients who are typically recommended for glaucoma surgery include:

  • Pediatric patients with primary congenital glaucoma, who may benefit from goniotomy and trabeculotomy as initial treatments.
  • Older, phakic patients who may benefit from trabeculectomy with adjunctive mitomycin C.
  • Younger children and patients with aphakic glaucoma who may benefit from glaucoma drainage devices.
  • Patients in whom filtering surgery has failed, who may benefit from cyclodestructive procedures as a last resort.

It is important to consider the specific characteristics and needs of each individual patient when determining the most appropriate surgical approach for glaucoma management.

Timeline

Before glaucoma surgery:

  1. Patient undergoes a comprehensive eye examination, including measurement of intraocular pressure, visual field testing, and examination of the optic nerve.
  2. Ophthalmologist determines the severity of the glaucoma and recommends surgery as a treatment option.
  3. Patient discusses the risks and benefits of surgery with the ophthalmologist and decides to proceed with the procedure.
  4. Patient undergoes preoperative testing and preparation for surgery.

After glaucoma surgery:

  1. Patient may experience some discomfort or blurred vision immediately following surgery.
  2. Patient is given eye drops or other medications to prevent infection and reduce inflammation.
  3. Patient may need to wear an eye patch or shield for a short period of time to protect the eye.
  4. Patient is instructed on postoperative care, including how to properly care for the eye and when to follow up with the ophthalmologist.
  5. Patient may need to attend follow-up appointments to monitor the success of the surgery and adjust medications as needed.
  6. Patient may experience improved vision and reduced intraocular pressure in the weeks and months following surgery.
  7. Ophthalmologist continues to monitor the patient’s condition to ensure long-term success of the surgery.

What to Ask Your Doctor

  1. What type of glaucoma surgery do you recommend for my specific condition?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the success rate of the surgery for patients with my type of glaucoma?
  4. What is the recovery process like after the surgery?
  5. Will I need to take any medications or follow a specific treatment plan after the surgery?
  6. How long will it take for me to see improvement in my vision after the surgery?
  7. Are there any alternative treatments or procedures that I should consider before undergoing surgery?
  8. How often will I need to follow up with you after the surgery?
  9. Are there any lifestyle changes or precautions I should take to prevent further damage to my eyes after the surgery?
  10. Can you provide me with references or resources to learn more about the surgery and my condition?

Reference

Authors: Chang I, Caprioli J, Ou Y. Journal: Dev Ophthalmol. 2017;59:165-178. doi: 10.1159/000458495. Epub 2017 Apr 25. PMID: 28442696