Childhood Glaucoma Surgery in Developing Countries

  • Anil K. Mandal
  • Sirisha SenthilEmail author


Childhood glaucoma affects more than 300,000 children worldwide; two-thirds of these children are already blind, and three-fourths of them live in developing countries. The high prevalence rate of primary congenital glaucoma (PCG) in the developing world is due to higher parental consanguinity in some communities. There is also a high incidence of secondary glaucomas associated with aphakia and pseudophakia, post-trauma, and steroid use. Caring for children with glaucoma is challenging due to its wide variability in presentation and clinical course with various treatment options and response to treatment. Surgery is the mainstay of treatment for most childhood glaucomas, especially PCG, with early surgery leading to a better prognosis. However, in developing countries, children tend to present late with advanced disease at presentation, resulting in delayed diagnosis and surgery. Primary combined trabeculotomy-trabeculectomy is often the preferred technique in the developing world. Although it has good success rates initially, surgical failure increases with time and is higher in eyes with greater severity of disease at presentation. Many such children need multiple surgical procedures for intraocular pressure (IOP) control. When primary surgery fails, medical treatment is initiated with appropriate glaucoma medications. If medical treatment is ineffective, trabeculectomy with antiscarring agents or glaucoma drainage device (GDD) implantation is the next choice. In eyes with uncontrolled IOP and poor or nil visual potential or with severely scarred conjunctiva precluding a GDD procedure, transscleral cyclophotocoagulation is preferred. The management of these complex cases does not end with surgery; close follow-up and visual rehabilitation help to achieve substantial success.


Primary congenital glaucoma Combined trabeculotomy and trabeculectomy Refractory pediatric glaucoma Developing countries Childhood glaucoma surgery Glaucoma drainage device surgery 

Supplementary material

Video 11.1

Surgical technique of combined trabeculotomy-trabeculectomy in a case of primary congenital glaucoma presenting with acute corneal hydrops. (Courtesy of Anil K. Mandal, MD, FAMS, L. V. Prasad Eye Institute, Hyderabad, India) (MPG 147496 kb)

Video 11.2

Step-by-step surgical technique for Aurolab aqueous drainage implant surgery . (Courtesy of Sirisha Senthil, MS, FRCS (Edin), L. V. Prasad Eye Institute, Hyderabad, India) (MOV 90142 kb)

Video 11.3

Step-by-step surgical technique for Ahmed glaucoma valve surgery . (Courtesy of Sirisha Senthil, MS, FRCS (Edin), L. V. Prasad Eye Institute, Hyderabad, India) (MOV 92554 kb)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Glaucoma and Pediatric OphthalmologyL. V. Prasad Eye InstituteHyderabadIndia

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