Learning From Children

Pediatric glaucoma can be a devasting and difficult disease for patients and ophthalmologists alike, but in our experience, it is one of the most rewarding conditions to treat. It is also perhaps the only potentially curable form of glaucoma: Published rates of complete success for angle-based surgery in primary congenital glaucoma are as high as 80% to 90%.^1,2

For the upcoming AGS 40th anniversary supplement to Ophthalmology Glaucoma, we delved into the history of pediatric glaucoma, which once left almost all affected patients blind, in pain, or enucleated before Barkan’s introduction of goniotomy in the 1930s. Refinements in microsurgical instruments and techniques, such as operating microscopes, OVDs, suture material, intraocular instruments, illuminated catheters, and tube shunts, led to more advanced surgical techniques. The past 80 years have brought the development of ab externo trabeculotomy by Burian and Allen in the 1960s,³ the use of a suture for circumferential trabeculotomy by Beck and Lynch in 1995,⁴ the adoption of illuminated microcatheters, and most recently, the introduction of gonioscopy-assisted transluminal trabeculotomy, as described by Grover in 2014.⁵

Many MIGS procedures now used regularly in adult patients were developed based on the time-honored tradition of treating the angle first in pediatric patients. Although many GT readers may not treat children with glaucoma during their careers, the lessons and considerations shared in this issue offer guidance on the treatment of adult patients who do not “read the book.”