![]() Broughton and Parks also reported their 20-year experience with 50 eyes of patients with primary congenital glaucoma who underwent goniotomy, obtaining an overall 88% success rate (with a mean followup of five years) after one or more goniotomies. Shaffer described 287 operated eyes and stated that one or two goniotomies cured 94% of patients diagnosed with glaucoma between 1 month and 24 months of age. In 1953, Barkan himself described his 17-year results of treating congenital glaucoma with goniotomy and reported an 80% success rate in 188 eyes, with adequate pressure control without medications. The results are excellent when used in patients fulfilling the criteria outlined above. The main aims and steps of the procedure have remained unchanged and include entering the anterior chamber through a clear corneal incision and crossing the anterior chamber to the opposite side to incise the trabecular meshwork (while visualizing the angle with a surgical gonio lens) and covering an arc of 100–110 degrees. ![]() Modifications allowed to combine goniotomy with the use of the surgical microscopes, which were introduced into ophthalmology in the early 1950's, but routinely used in large eye institutions dealing with this disease (such as Moorfields Eye Hospital in London) until the late 1960's. Although initially used by De Vincentis, in 1893, for all types of glaucoma, Barkan is credited with combining it with gonioscopic view, giving a detailed description of the procedure and reporting its successful use in congenital glaucoma in 1938. This is the oldest procedure described for treating congenital glaucoma. The purpose of this paper is to review the literature on the techniques currently available and their results, for the management pediatric glaucoma, and to offer guidelines on what elements to consider when taking a surgical decision for these patients. The prognosis of the disease has significantly improved over the last half century because of the development of angle surgery, trabeculectomy, seton implantation, and use of antimetabolites. Traditional surgical procedures are evolving, and the choices are increasing as diagnostic advances, surgical instrumentation, and newer techniques emerge. Depending on the age of the patient, it presents with particular features and circumstances that need to be taken into account and frequently require surgical intervention. Pediatric glaucoma includes a wide variety of conditions which result in elevated intraocular pressure and optic nerve damage, ranging from primary congenital glaucoma since birth to developmental glaucoma associated with other diseases and acquired glaucoma secondary to multiple causes. Although the outcome of surgical treatment in pediatric glaucoma has improved significantly, its treatment remains challenging. This paper reviews the different surgical techniques currently available, their indications, results, and most common complications to allow the surgeon treating these conditions to make a more informed choice in each particular case. More recently, seton implantations of different types have become more popular to use in children, and newer techniques have become available including visualized cannulation and opening of Schlemm's canal, deep sclerectomy, trabectome, and milder more directed cyclodestructive procedures such as endolaser and transcleral diode laser cyclophotocoagulation. Traditionally, goniotomy and trabeculotomy ab externo have been the preferred choices of treatment for congenital glaucoma, and a variety of adult procedures adapted to children have been utilized for other types of pediatric glaucoma with variable results and complications. ![]() Currently, there are numerous choices for the treatment of pediatric glaucoma depending on the type of glaucoma, the age of the patient, and other particularities of the condition discussed in this review.
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