Since trabeculectomy was embraced from adult glaucoma surgery in the 1970s for the treatment of childhood glaucoma, it has remained an indispensible and valuable part of the limited pediatric glaucoma surgical armamentarium, especially from a worldwide perspective. Its initial widespread popularity waned with time due to the significant complications associated with thin, avascular blebs and to the introduction of other surgical alternatives such as glaucoma drainage devices (GDD). However, the ability of trabeculectomy to achieve a low mean intraocular pressure (IOP) and be less dependent on medication for IOP control compared to GDDs led to the reevaluation and modification, rather than the abandonment of the technique. Subsequent changes to the surgical technique which encourage posterior aqueous flow (e.g., Moorfields Safer Surgery System: fornix-based conjunctival dissection, releasable sutures, and a wide area of antiscarring application) have resulted in pediatric trabeculectomy now being commonly associated with diffuse elevated blebs. Consequently, the importance of trabeculectomy within pediatric glaucoma surgery has been restored.
Trabeculectomy is often the procedure of choice after failed angle surgery especially when the superior conjunctiva has not been previously incised, or as primary surgery for phakic, secondary childhood glaucoma cases. Successful outcomes depend on case selection (e.g., phakic patients), using a contemporary surgical technique, the facility to closely monitor the child in the postoperative period including examinations under anesthesia for timely interventions such as removal of scleral flap sutures, and the parents’ ability to administer the intensive postoperative medication regime.
KeywordsPediatric trabeculectomy Moorfields Safer Surgery System Mitomycin C Filtering surgery Bleb-related infection Chronic hypotony Bleb leak
Pediatric trabeculectomy using the Moorfields Safer Surgery technique. (Courtesy of Maria Papadopoulos, MBBS, FRCOphth) (MOV 130555 kb)
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