Childhood Glaucoma Surgery: Perioperative Considerations
Managing glaucoma in childhood is one of the greatest challenges in the field of glaucoma, especially its surgical treatment, itself a critical component of management. Most children with glaucoma will require surgery in their lifetime, often in their childhood years. The surgical repertoire for childhood glaucoma has remained relatively unchanged for many years, with most progress resulting from modifications to existing surgery. Each surgical technique has its advantages and disadvantages, with potentially good success rates when chosen appropriately and performed with meticulous attention to detail to minimize complications. The aim of surgery is to eliminate or bypass aqueous flow obstruction. The challenge of surgery is to balance greater success with fewer complications. To achieve this fine balance, the surgeon often modifies and develops a technique that is safe. Internationally, approaches to surgery for childhood glaucoma can vary, but these highly specialized operations should preferably be performed by a trained surgeon in centers with sufficient volume of patients to ensure surgical experience and skill, coupled with safe anesthesia. Given that most children with glaucoma have normal life expectancies and may therefore need several operations to control intraocular pressure, the impact of successful surgical treatment on the patients and their families cannot be underestimated. We hope that in the new millennium, evidence from surgical trials will better guide the management of children with glaucoma and that surgical techniques will continue to evolve for greater success and safety.
