Current Surgical Options for the Management of Pediatric Glaucoma

Table 1

Summary of the advantages and disadvantages for either procedure.

Goniotomy		Trabeculotomy
Pros	Cons	Pros	Cons
Simpler	Requires a degree of corneal clarity	It can be done even with cloudy cornea	More elaborate procedure (it requires accurate identification of Schlemm’s canal)
Faster procedure	Introduction of sharper instruments across the anterior chamber (higher risk of damage to intraocular structures), and an assistant is needed to tilt the patient’s head	No need to introduce sharp instruments across anterior chamber	More lengthy procedure
Does not disturb conjunctiva	Better success before age 3	It can be converted to trabeculectomy	It disturbs conjunctiva
Direct visualization of TM		Eliminates entire TM as obstacle and works in situations with multiple mechanisms exist, such as impermeability of inner wall or collapse of Schlemm’s canal
More targeted cutting of abnormal tissue in primary congenital glaucoma		Success reported even in patients older than 3
May repeat one or more times			May repeat only one time
If the cornea is sufficiently clear it is usually possible to identify target tissue		Not always able to find Schlemm’s canal (3–15% cases)