Management of primary congenital glaucoma in the Indian population

Primary congenital glaucoma (PCG) is a leading cause of childhood visual impairment and blindness worldwide, with a disproportionately high burden in low- and middle-income countries such as India. Early diagnosis and prompt surgical intervention are critical to prevent irreversible vision loss in affected children. This study aimed to review and synthesize current evidence on surgical management strategies for PCG in the Indian context. The objective was to identify the most effective, evidence-based surgical approaches to optimize outcomes in Indian children with PCG. A comprehensive narrative review was conducted, followed by a systematic literature search of PubMed, Google Scholar, and Scopus databases for the surgical management strategies in Indian context for PCG eyes. Keywords included "Primary congenital glaucoma," "trabeculotomy," "trabeculectomy," "goniotomy," "glaucoma drainage devices," "complications," and "India." Only English language articles with full text availability were included. Data were extracted and analyzed to compare surgical outcomes and determine best practices. Trabeculotomy and goniotomy remain first-line surgical interventions, with combined trabeculotomy-trabeculectomy showing superior long-term success rates in the Indian population. Glaucoma drainage devices are primarily reserved for refractory or advanced cases. Lifelong monitoring is essential due to the potential decline in surgical success over time. In the Indian setting, combined trabeculotomy-trabeculectomy represents an effective, evidence-based surgical strategy for PCG management. Early surgical intervention and individualized treatment remain critical to preserving vision and reducing blindness in affected children.