Developmental and childhood glaucoma

Surgical interventions for primary congenital glaucoma

“…We used five years as the cut-off because by definition, glaucoma diagnosed after five years is classified as juvenile glaucoma (Stamper 2009). We included trials in which children diagnosed both before and after the age of five years were included when data for the subgroup of children under five years were reported separately.…”

“…Primary congenital glaucoma (PCG) occurs before five years of age and is not associated with any other systemic or ocular abnormality apart from isolated trabeculodysgenesis (malformation of the trabecular meshwork) (Stamper 2009). …”

“…Corneal changes are often the presenting features of PCG and result in the classical clinical triad of epiphora (excessive tearing of eyes), blepharospasm (involuntary blinking of the eyelids), and photophobia (light sensitivity). Corneal diameters that are asymmetric, or a corneal diameter greater than 13 mm at any age, or greater than 11.5 mm at birth (normal 9.5 mm to 10 mm at birth and 10 mm to 12 mm at two years) warrant further evaluation for glaucoma (Allingham 2005a; Kiskis 1985; Sampaolesi 1982; Stamper 2009). Other corneal changes include corneal edema, corneal haze, Haab’s striae (breaks in Descemet’s membrane), and corneal opacities.…”

“…Other corneal changes include corneal edema, corneal haze, Haab’s striae (breaks in Descemet’s membrane), and corneal opacities. An axial length (AL) greater than 20 mm at birth (normal 16 mm to 17 mm) or 22.5 mm at one year (normal 20.1 mm) is suspicious for glaucoma (Stamper 2009). Gonioscopy in eyes with PCG shows a characteristic angle structure with an anterior iris insertion, fine iris processes, and altered translucency of the angle face, historically called the Barkan’s membrane (Allingham 2005a; Barkan 1955).…”

“…Surgical therapy is the accepted standard treatment for PCG, with angle surgery (goniotomy or trabeculotomy) generally used as the primary intervention (Allingham 2005b; Stamper 2009). There is considerable heterogeneity in the management of PCG even amongst experts in the field.…”