Current concepts in the diagnosis and management of developmental glaucomas

Developmental glaucoma is a global problem and has a broad range of ocular manifestations and is sometimes associated with systemic disorders and syndromes. It poses a major diagnostic and management problem to the ophthalmologists. A proper diagnostic evaluation under general anesthesia is advisable for all children who do not cooperate for an office examination. Surgery remains the principal therapeutic modality in the management of developmental glaucoma and medical therapy is limited to a supplemental role while the child is being prepared for surgery. Conventional angle incision surgery (goniotomy and trabeculotomy ab externo) is uniquely valuable in the management of primary developmental glaucoma, while combined trabeculotomy cum trabeculectomy offers the best hope of success in advanced cases. In recent years, artificial drainage devices such as the Molteno implant seem to be promising for safe and effective pressure control in children with refractory developmental glaucoma. Visual rehabilitation involves correction of refractive errors, removal of opacities in media (i.e. cataract or corneal scarring) and aggressive amblyopia therapy. Early diagnosis, prompt institution of therapy combined with commitment from the family for postoperative follow-up care are critical for the restoration of good visual function.