Congenital Glaucoma is one of the most common causes of irreversible childhood blindness. This presentation covers this topic in detail that can aid physicians in effective patient care. PS: The slides in the preview look skewed, download the presentation to view the font used in Office 2012 and upwards.

1. Presented By: Dr. Sahil Thakur
Consultant Incharge: Dr. Suresh Kumar

2. Terminology
Classification Systems
Epidemiology and Genetics
Pathogenesis
Clinical Presentation
Diagnostic Examination
EUA
Medical Management
Surgical Management
Visual Rehabilitation
Impact of Childhood Glaucoma
Conclusion

3. According to age of onset
 CONGENITAL GLAUCOMA: Glaucoma exists at birth and usually before birth
 INFANTILE GLAUCOMA: Birth till 3 years of age
 JUVENILE GLAUCOMA: After the age of 3 years
This terminology lacks clear cut demarcation so use is discouraged

4.  Rare vision threatening heterogeneous group of diseases
 According to Shield’s classification of Childhood Glaucoma
PRIMARY GLAUCOMA SECONDARY GLAUCOMA
Congenital OAG Traumatic glaucoma
Juvenile open angle glaucoma Secondary to intraocular neoplasm
Associated with ocular abnormalities Secondary to uveitis
Associated with systemic abnormalities Lens induced glaucoma
After surgery for congenital cataract

5. PRIMARY: Due to maldevelopment of aqueous outflow
system
SECONDARY: Damage to aqueous outflow system due to
maldevelopment of some other portion of eye

6. HOSKIN’S
CLASSIFICATION
ISOLATED
TRABECULODYSGENESI
S
IRIDODYSGENESIS CORNEODYSGENESIS
Peripheral
Mid peripheral
Central
Corneal size
Anterior stromal defects
Anomalous iris vessels
Structural anomalies
Flat iris insertion
Concave iris insertion
Does not include glaucoma in absence of developmental anomaly
HALLMARK OF PRIMARY CONGENITAL GLAUCOMA

7. ISOLATED TRABECULODYSGENESIS
It is associated with primary congenital or developmental
glaucoma
IRIDO TRABECULODYSGENESIS
Anterior stromal defect
Hypoplasia of iris stroma
Malformation of iris collarette
Absence or marked reduction of crypt layer
Common anomaly seen in Axenfield’s and Rieger’s anomaly
Hyperplasia of iris stroma
Diffuse thickening of iris

8. Anomalous iris vessels
Persistence of tunica vasculosa lentis
Anomalous superficial vessel
Structural anomalies
Holes, Aniridia and Colobomata
CORNEO IRIDO TRABECULODYSGENESIS
Peripheral corneal lesions extend no more than 2mm into clear
cornea e.g. Posterior embryotoxon ( Axenfeld’s anomaly )
 Mid peripheral or central opacities with thinning of stroma
Microcornea: Rubella , PHPV , Nanophthalmos , Rieger’s
anomaly
Megalocornea: Axenfeld’s syndrome

9. PRIMARY CHILDHOOD
GLAUCOMAS
SECONDARY CHILDHOOD GLAUCOMAS
IA Primary congenital
glaucoma
IB Juvenile open angle
glaucoma
IIA Glaucoma associated with non
acquired ocular anomalies
IIB Glaucoma associated with systemic
disease or syndrome
IIC Glaucoma associated with acquired
condition
IID Glaucoma following congenital
cataract surgery
Classification developed by members of CGRN and vetted by consensus committee of WGA in
July 2013

10. IA PRIMARY CONGENITAL GLAUCOMA Isolated angle anomalies
Meets glaucoma definition
Spontaneously arrested cases but with typical
signs of PCG
IB JUVENILE OPEN ANGLE GLAUCOMA No ocular enlargement
No associated ocular anomalies /syndromes
Open angle
Meets glaucoma definition

11. Axenfeld’s Reiger anomaly
Peter’s anomaly
Ectropion uveae
Congenital Iris Hypoplasia
Aniridia
Oculodermal melanocytosis
Posterior Polymorphous Dystrophy
Microphthalmos
Microcornea
Ectopia lentis
IIA Conditions with predominantly ocular anomalies present at birth may or
may not be associated with systemic signs

12. IIB Conditions predominantly with known syndromes systemic anomalies or
systemic disease present at birth which may be associated with ocular signs
 Chromosomal disorders
 Connective Tissue Disorders
Marfan’s Syndrome, Weil Marchesani’s Syndrome and Stickler’s Syndrome
 Metabolic disorders
Homocysteinuria , Lowe’s Syndrome and Mucopolysaccharidosis
 Phacomatosis
Neurofibromatosis, Sturge Weber and Klippel Trenuanay Weber Syndrome
 Congenital Rubella

13. IIC Glaucoma associated with acquired conditions which are
not inherited or present at birth but develop after birth
Uveitis
Trauma
Steroid induced
Tumors
Retinopathy of Prematurity

14. IOP> 21 mm of Hg plus at least one of the following:
Optic disc cupping
 Progressive increase in VCDR
 Cup disc asymmetry of 0.2 or more
 Focal rim thinning
Corneal findings
 Haab’s striae
 Diameter ≥11 mm in new born
 Diameter > 12 mm in < 1 yr old child
 Diameter > 13 mm any age
Ocular enlargement like Progressive myopia / increasing axial length
Visual field defect consistent with glaucomatous optic neuropathy with no
observable reason for defect

15. Eyes meeting the CGRN glaucoma definition criteria are subcategorized
into three groups on the basis of age:
Neonatal: 0-1 month
Infantile: 1 -24 months
Late onset or late recognized: > 2 years
DEFINITION OF GLAUCOMA SUSPECT
Any 1 of the following
 IOP> 21 mm of Hg on two separate occasions
 Suspicious optic disc appearance for glaucoma
 Increased CDR
 Increased corneal diameter or axial length in setting of normal IOP
 Supicious visual field defect for glaucoma

17. INCIDENCE
 Congenital glaucoma is responsible for between 4% and 18% of childhood blindness.
 In developed countries incidence is 1 in 10000 births
 1 in 1250 in Slovakia
Ophthalmologica. 1972;181:61–73
 1 in 3300 in Andhra Pradesh
Arch Ophthalmol. 1998;116:545–6
 In the Toronto experience, a review of 306 children diagnosed with childhood glaucoma,
congenital glaucoma 38% followed by aphakic glaucoma 20% and Sturge–Weber syndrome-
associated glaucoma 10%.
J AAPOS 1999; 3: 308-15.
 In Dallas study 23% of patients had primary glaucoma, 45% had secondary glaucoma, and 31%
were glaucoma suspects.
Clinic Ophthalmol .2013; 7:1739-46

18. GENETICS
 Sporadic
 Familial patterns show recessive inheritance with variable degree of penetrance and
multi factorial inheritance
 Increased incidence with high consanguinity
Arch Ophthalmol 1998;116(4):545–546
LOCUS LOCATION INHERITANCE GENE
GLC3A 2p21 AR CYP1B1
GLC3B 1p36 AR ?
GLC3C 14q24.3 AR ?
Genomics 1995;30:170-177
IOVS 2002; 43:
3015
GENETIC LOCI FOR PRIMARY CONGENITAL GLAUCOMA

19.  Although spectrum of mutations in CYP1B1 have been implicated in
PCG
 Very few reported genotype phenotype correlations
 Frameshift and R 390C are associated with severe phenotypes and
poor prognosis
IOVS April 2004 ;45 :1149-56

20. PRIMARY
CONGENITAL
GLAUCOMA
Faulty atrophy
of mesodermal
tissue
Faulty cleavage of
mesodermal tissue
Excessive collagenous
beams preventing
posterior sliding of iris
and ciliary body leading
to anterior iris insertion
and TM obstruction
Abnormal
migration of
neural crest
cells

21. TM
Ciliary
muscle
5 months :Iris meets
endothelium
TM & ciliary muscle
overlapping
Allen et al :Arch Ophthalmol 53:783 1955
Cleavage of
mesodermal tissue
Normal development
of the angle

22. Uveal tract splitting
by cleavage or
atrophy ciliary
muscle is seen
extending into iris
Differential growth rate leading
to slippage of ciliary muscle and
ciliary body posteriorly

23.  Typically bilateral but significant IOP elevation in one eye can occur in 25- 30 % of
cases
 Commonly between 3-9 months
 Rarely at birth or up to 3 years of age

24. Site Signs
Cornea Megalocornea
Breaks in Descemet’s membrane
Haab’s Striae
Sclera Increased axial length
Myopia
Astigmatism
Optic Nerve Cupping
IOP Increased

25. Cornea
Megalocornea
Corneal clouding
Breaks in Descemet’s
membrane
Haab’s Striae
Horizontal or curvilinear striae
formed as endothelial cells lay
down new basement membrane
and hyaline ridges develop

26. Sclera
Scleral thinning
Blue sclera
Increased Axial
length
Myopia
Astigmatism

27. Lens
Stretching and rupture of
zonules can cause lens
subluxation
Optic nerve cupping
Rapid and early
Reversible with normalization of
pressure

28.  To confirm the diagnosis of glaucoma
 Determining the type of glaucoma if present
Initial Evaluation
• Adnexal source of irritation
• Lacrimal system obstruction
• Visual response
• Corneal edema
• Opacification
• Preliminary digital tonometry

29. IOP evaluation can be done in sleepy infant or during bottle feeding
using:
 Perkin’s Applanation Tonometer
 Tonopen
5-6 yr old child:
 GAT evaluation can be done

30. Refraction and Perimetry
Myopia
Astigmatism
Visual Fields yield valuable information in older children
Anterior Segment Evaluation
Using portable slit lamp
UBM: to detect any associated anterior segment anomalies
Posterior Segment Evaluation
With direct or indirect ophthalmoscope if there is no corneal
clouding or opacification
B scan USG

31. EVALUATION UNDER
ANAESTHEISA
Sequence For EUA
Corneal Diameter
Tonometry
Anterior Segment Evaluation
Gonioscopy
Fundus
Refraction
Pachymetry
Axial Length Measurement
To avoid unnecessary anesthesia ophthalmologist undertaking EUA should be able
to perform surgery if indicated

32.  Haab’s striae
 Corneal edema
 Corneal opacification: 80% of patients
 Posterior embryotoxon
 Megalocornea
 Measurement of Corneal Diameter:
Hold the calipers on first appearance of
white scleral fibers on one side and same
point on other side. Accurate measurement
using plastic gauge with calibrated holes.
Can J Ophthalmology 1985; 20:93–97.
CORNEAL FINDINGS

33. Age Normal Megalocornea
Term 9.5 -10.5 11.5
1 yr 10-11.5 12-12.5
2yr 11-12 >12.5
Older child <12 >13
Sherwin Isenberg Formula in preterm babies
Corneal Diameter=0.0014 * wt in gm + 6.3

34. Normal IOP varies with age:
 Mean IOP up to 12 year of age is12.2 +/-0.74 mm of Hg
 Mean IOP < 1 year of age is 8 +/- 2.5 mm of Hg
J Pediatr Ophthalmol & Strabismus 2006; 43: 14
Tonometers
 Perkin’s hand held Applanation Tonometer
 Tonopen
 Schiotz Tonometer should be avoided
Sources Of Error
 Effect of anesthesia
 Corneal surface distortion , edema
 Mackay Marg Tonometer is accurate
IOP MEASUREMENT

35. ANAESTHETIC AGENTS
AFFECT IOP
IOP
Increased
Succinylcholine
Ketamine
Endotracheal
Intubation
Decreased
Halothane
Oxygen
Nitrous oxide
Sevoflurane
Midazolam
Methohexitol
Only raised IOP in EUA should never be the basis of diagnosis and treatment

36. Portable Slit Lamp
Corneal findings
Anterior chamber depth
Anatomy of iris

37. Direct gonioscopy using Koeppe’s type direct
goniolens with hand held slit lamp or
microscope:
Anterior insertion of iris with altered
translucency of angle
Lister’s morning mist: fine fluffy tissue covering
peripheral iris
Lochness Monster Phenomenon: loop of
vessels of major arterial circle can be seen
above iris
Can visualize fundus through the same lens
(in undilated pupil and with corneal edema )
GONIOSCOPY

38. Type 1 Type II
The Glaucomas,
Sampolesi, Springer, 2013

39. Possible if corneal edema or opacity do not hinder evaluation
Avoid dilation if surgery is contemplated
Direct ophthalmoscope
Koeppe’s lens can be used with direct ophthalmoscope in
small pupil
Careful drawings and fundus photographs (using hand held
fundus camera )
OPTIC NERVE HEAD
EVALUATION

40. A scan measures axial length , anterior chamber depth , lens
thickness
Baseline value for comparative purpose
B scan for posterior segment if opaque media precludes the
view
Can be used to visualize retinal or choroidal detachment/
mass lesion / etc.

41. PARAMETER NORMAL MILD MODERATE SEVERE
Corneal Diameter
(mm)
upto10.5 >10.5-12 >12-13 >13
IOP (mm of Hg) 11.5 11-20 >10-30 >30
Cup Disc ratio 0.3-0.4 >0.4-0.6 >0.6-0.8 >0.8
Last BCVA 20/20 <20/20-20/60 <20/60 – 20/200 <20/400- no PL
Panicker et al IOVS 2004;45 :1149-56

42. DIFFERENTIAL DIAGNOSIS BASED
ON SYMPTOMS
 Epiphora and red eye
 Conjunctivitis
 Nasolacrimal duct obstruction
Corneal epithelial defect
 Keratitis
 Anterior segment inflammation
 Conditions associated with corneal
edema or opacification
Birth trauma
Congenital malformation
Corneal dystrophy
Keratitis
Mucopolysaccharidosis
Idiopathic

43.  Conditions showing corneal enlargement
Myopia
Conditions showing actual or pseudo optic nerve
cupping
Physiologically large optic nerve cup
Coloboma
Atrophic optic nerve
Hypoplastic optic nerve
Malformation

44. Confirm The
Diagnosis Of PCG
Preoperative appropriate
Medical Treatment
Angle Surgery
Goniotomy
Trabeculotomy
Trabeculectomy and
Trabeculotomy
Cyclodestructive
procedures
Follow up
Lifetime
Amblyopia treatment once
IOP contolled

45. SUPPORTIVE ROLE
Preoperative :clear cornea for angle surgery
Adjunctive modality: in combination with surgery if IOP is
too high
Temporary measure if infant is unfit for surgery
ISSUE OF DRUG SAFETY IN CHILDREN
Smaller plasma volumes
Immature blood brain barrier
Increased receptor sensitivity
Increased systemic absorption
MEDICAL TREATMENT

46. MEDICATIONS INDICATION CONTRAINDICATION
B BLOCKERS
Non selective- (timolol -
0.1 ,0.25 ,0.5 %)
Selective (for reactive
airways )- betaxolol
1st line
2nd line for older children
Avoid in children with
reactive airways , cardiac
disease
Side effects:
bronchospasm
bradycardia
CAI
(Oral acetazolamide -5-
15mg/kg suspension )
Dorzolamide 2%
Brinzolamide 1%
1st line / 2nd line – young
children
Avoid in children with
corneal transplant
Prostaglandins
Latanoprost 0.005%
Bimatoprost 0.03%
Travoprost 0.004%
2nd / 3rd line Trichomegaly
Redness
Preoperative use – risk
of inflammation
Latanoprost use licensed in Europe since 2010 based on PANDA results

47. MEDICATION INDICATION CONTRAINDICATION
Miotics Diarrhoea
Interaction with
succinylcholine for GA
Headache ,
proinflammatory
Adrenergic agonist
Epinephrine
Apraclonidine
Brimonidine
Not used
Short term use in infants
and after corneal
transplant
Only in older children 3rd
line or last resort
Lack of efficacy
DO NOT USE IN
INFANTS / SMALL
CHILDREN
Lipophilic drugs –CNS
side effects fatigue ,
somnolence

48. Definitive therapy in most cases
Western world
 Early presentation with mild corneal edema at referral
 Goniotomy is the treatment of choice
In India / Middle east
 Late presentation
 Goniotomy is not possible
 Trabeculotomy or combined trabeculectomy and trabeculotomy

49.  OBJECTIVE : Remove the obstructing tissue that causes resistance to
aqueous outflow
 LENS: Swan Jacob lens
 KNIFE: Barraquer knife
Worst knife
Swan spade
Long needle
Reported results show success rate of 80% J AAPOS.2001;5:281–4
GONIOTOMY

50. Pre-op Preparation
 Adequate miosis
 Facilitates retraction of iris from angle
Steps
 After placing the goniotomy lens over cornea
 Anterior chamber is entered through a clear corneal incision (e.g. nasal
goniotomy – temporal incision is given )
 Knife is advanced towards the opposite angle parallel to iris and away from
pupil and the angle is engaged by the blade tip which is swept
circumferentially incising the nasal angle over 100-110 degree. Falling back of
peripheral iris is the end point of surgery

52. Failure
Failure of obtaining adequate incision during surgery
Presence of peripheral anterior synechiae
Fibrous proliferation
Success rate of 70 – 93 % in large series after multiple
goniotomies
Ophthalmology 2011;118:236-40

53. TRABECULOTOMY AB
EXTERNO
Independently described by two surgeons in 1960
Burian: Trabeculotomy ab externo
Smith: Nylon filament Trabeculotomy
Beck and Lynch: 360 degree trabeculotomy using 6-0
polypropylene
Recent: Illuminated Microcathether
Principle: To cannulate Schlemm’s canal from external
approach and then tear through TM into anterior chamber

54. Limbal or fornix based
Conjunctival flap is made
Hemostasis is achieved with
minimal cautery
Junction of Posterior border of
TM and Sclera is the external
landmark for scleral spur and
Schlemm’s canal – radial
incision is given at this site
Incision is deepened till inner
wall of Schlemm’s canal and
trabeculotome is introduced

55. Trabeculotome is rotated till
75% of probe is seen in AC
Rotation is reversed and
instrument is withdrawn
Trabeculotome is then
passed into Schlemm’s canal
on other side radial incision

56. GONIOTOMY VS
TRABECULOTOMYGoniotomy Trabeculotomy
Simple faster procedure Can be done in edematous or scarred cornea
Does not disturb conjunctiva Does not require introduction of sharp
instruments in anterior chamber
Can be repeated one or more times Does not require adaptation to gonioprism
Can be converted to trabeculectomy

57. COMBINED TRABECULOTOMY AND
TRABECULECTOMY WITH /WITHOUT
MMC
 Trabeculectomy combined with trabeculotomy to increase the long term
success
 Primary CTT : single operative procedure with better control of IOP in some
populations e.g. India
Trabeculotomy vs Trabeculectomy vs Combined procedure
 Favourable outcome with combined procedure but after 2 years advantage
was not statistically significant
Br J Ophthalmol 1999;83:317–322.
 Mandal et al Primary CTT without MMC in299 eyes of 157 patients reported a
success rate of 63.1 % by the end of 1 year
Ophthalmology 2004; 111:283–290

58. Intraoperative use of mitomycin C has somewhat enhanced the
success of procedure but with significant risk of complications
 Complications with MMC use in children
Thin walled avascular bleb : risk of endophthalmitis
Bleb leaks
Wound rupture
One reported series of retrospective comparison of
trabeculectomy with or without MMC noted no significant
difference in outcome
J Glaucoma 2004;13:228–232

59. REGULAR FOLLOW UP
For IOP monitoring
Retinoscopy
Amblyopia Therapy
Optical Keratoplasty

60. SURGICAL SUCCESS
Corneal clarity
Decreased IOP
Pale blebs
Reversal or non progression of disc cupping
Reversal or non progression of myopia
Good visual recovery
Surgical success has been defined as IOP <16 under GA or IOP <
21 mm of Hg with no progression of cupping or corneal diameter
Qualified success: Maintenance of above pressures with single drug

61.  Total of 148 eyes (85 patients)
 Trabeculotomy, trabeculectomy, or combined trabeculotomy-trabeculectomy (CTT)
were compared: equal success rate
 Overall success rate was 80.4%
 One surgery 105 (70.9%), 34 eyes (23.0%) 2 surgeries, and 7 eyes (4.7%) had 3
surgeries
 A progressive decline in success rate over time was evident, as success rate dropped
from 96.6% at 5 months to less than 50% after 11 years of follow-up
 Surgical outcome of PCG better in infants presenting before 6 months
 Adjuvant topical anti glaucoma medications augment success rate

62. MANAGEMENT OF
REFRACTORY GLAUCOMA /
FAILED SURGERY
UNFAVOURABLE FACTORS IN PEDIATRIC GLAUCOMA
Low scleral rigidity
Rapid healing process
Exuberant scarring process
Enlargement of glaucomatous eyes with thinning and
distortion of intraocular anatomy

63. TRABECULECTOMY WITH OR
WITHOUT MMC
Indication
Failed Angle Surgery
Secondary Glaucomas
Success Rate
Variable results in literature

64. Non Valved
Molteno
Baerveldt
Valved
AGV
Indications
Failed filtration surgery
Failure to control IOP with
medication post surgery
Aphakic glaucoma
Neovascular glaucoma
GLAUCOMA DRAINAGE
DEVICES

65. AGV vs. Baerveldt vs MMC trabeculectomy in children <2 yrs:
 Retrospective study; Better IOP control with the GDDs than the MMC trabeculectomy
group
 Cumulative success rates of 87% versus 36%, respectively, at 1year and even a
larger difference of 53% versus 19% at 6 years.
Am J Ophthalmol 2004;137 (6):1163–1164
AGV vs MMC trabeculectomy in pediatric aphakic glaucoma:
 Prospective, randomized study
 Higher qualified success in the AGV(67%) vs the MMC trabeculectomy group (40%)
 Complication rates higher in the MMC trabeculectomy (40%) than
AGV(26.7%)(differences were not statistically significant).
Saudi Journal of Ophthalmology, 2011; 25:317–27

66. CYCLODESTRUCTIVE
PROCEDURES
Indications
 Failed angle surgery with
minimal visual potential
 Failed trabeculectomy /
GDD with poor central
vision
 Anatomy precludes
intraocular glaucoma
surgery
Options
 Trans-scleral cycloablation
(Diode laser )
 Endoscopic diode laser
cycloablation
 Cyclocryotherapy

67. 21 year follow up
53 eyes included
Mean logMAR VA was 0.61 ± 0.57.
Good VA in 51%, Moderate VA in 30%, and Poor VA in 19%
Deprivation Amblyopia (64%) was main cause of visual
impairment with VA <20/50

68. VISUAL
REHABILITATION
Appropriate spectacle correction
If problem persists for distance
vision even telescopes can be
prescribed
Appropriate training for
recommended device is must

69. VISUAL
REHABILITATIONRetrospective study of B/L congenital glaucoma
 100 children, mean age 6.3 yrs (1 month-16 years)
 Success rate of early treatment is 70 to 80%
 Only 35% of all patients will have visual acuity better than 20/50, and 2% to
15% will remain blind.
 Regarding the optical prescriptions, 80% were corrected for myopia and
20% were for hyperopia and astigmatism.
 Optical devices for distance were prescribed for 34% of the patients. All of
the optical aids for distance were telescopic manual systems for one eye
only
 Optical aids for near vision were necessary for 6% of the patients, and the
most commonly prescribed were illuminated stand magnifiers of + 38
aspheric diopters
Clinics 2009;64(8):725-30

70. Consider repeat trab,
Drainage implant,
Cyclodestruction.
Goniotomy/Trabeculectomy/Combined Trab-Trab
Surgical Outcome?
EUA after 3 weeks
IOP controlled
Evaluation after 3 months
Normal IOP
Evaluation after 3 months
FU every 3 months
Record IOP, CDR, VA
Axial length, VF (if possible)
IOP not controlled
Add medical therapy
If IOP not controlled
repeat Trab-Trab
Controlled
VISUAL
REHABILITATION
Uncontrolled
Very poor prognosis
BROAD MANAGEMENT OUTLINE

71. IMPACT OF CHILDHOOD
GLAUCOMA119 children in the study, all grades of glaucoma
Older children reported less impairment on CVAQC1, IVI-C2, and PedsQL
3than younger children.
Parents reported greater impact on their child's HR QoL than children
reported themselves.
Children with glaucoma report HR QoL scores similar to those described
by children with severe congenital cardiac defects, who have undergone
liver transplants, or who have acute lymphoblastic leukemia.
(1) functional visual ability (FVA) with the Cardiff Visual Ability Questionnaire for Children (CVAQC), (2) VR QoL
with the Impact of Vision Impairment for Children (IVI-C), and (3) HR QoL with the Paediatric Quality of Life
Inventory (PedsQL) version 4.0.

72. PROGNOSIS OF
CHILDHOOD GLAUCOMA230 patients with 10 year follow up
79 having ocular hypertension with open angles or primary angle closure
(PAC), 35 primary open angle glaucoma (POAG), 50 PAC glaucoma (PACG),
20 primary congenital glaucoma (PCG), 46 secondary glaucoma patients.
15% of primary congenital glaucomas (PCGs) showed a glaucomatous VF
defect after 10 years.
This study provides evidence that routine delivery of care can provide well
controlled IOP in glaucomas, both primary and secondary, and the VF
stabilized in about 90% of patients over a period of 10 years, with the
currently available glaucoma medications and trabeculectomy.

73. INDIAN PRACTICE
PATTERNS

74. CONCLUSION
Congenital Glaucoma is a potentially treatable cause of irreversible
childhood blindness provided it is picked up early.
CGRN classification should be done for each case.
EUA is the best method to clinically evaluate the patient.
IOP should be taken immediately after induction with Tonopen or
Perkin’s Tonometer to counter effect of anesthetic drugs.
Management is mostly surgical.
Goniotomy in West and Trab with augumented Trab forms the
mainstay in our setup.
Post operative life long follow up is vital.
Amblyopia should always be treated to improve the QOL of the
patient.