Further Surgical Options in Children

Table 121-1 compares the success rates and different features of interventions for refractory pediatric glaucoma. To date, no treatment has shown reliable IOP lowering over long periods of follow-up in all patients. In selecting a treatment, the practitioner must consider the long-term risks and benefits. The infection-prone anterior bleb following a successful trabeculectomy with mitomycin C has deterred many surgeons from this procedure as second-line treatment. Drainage implants may have a lower risk of infection, though problems with tube migration and exposure frequently require surgical revision. Cyclodestructive procedures, particularly cyclophotocoagulation, have a role in refractory cases, though there is a risk of devastating complications, including retinal detachment and phthisis.