This document outlines the approach to treating pediatric glaucoma. It discusses the basic principles, which include considering all treatment options in a logical sequence without compromising future procedures, and being aware of associated conditions. Examination under anesthesia is described as the key to diagnosis, classification, and monitoring, involving examination of the cornea, pressure, posterior segment, gonioscopy, and supplemental tests. Both medical and surgical treatments are discussed, including goniotomy, trabeculotomy, trabeculectomy, tube implants, and cyclodestructive procedures. Long-term resource planning is also emphasized.

1. APPROACH TO PEDIATRIC
GLAUCOMA
DR Saladin Mugharbel

2. APPROACH TO PEDIATRIC GLAUCOMA
 INTRODUCTION
glaucoma in children cannot be looked upon
in the same way as glaucoma in adult

3. APPROACH TO PEDIATRIC GLAUCOMA
 BASIC PRINCIPLES :
use All options in a logical & optimal sequence

4. APPROACH TO PEDIATRIC GLAUCOMA
 BASIC PRINCIPLES :
procedures done early should be planned not
to interfere , nor compromise the potential
success of subsequent procedures

5. APPROACH TO PEDIATRIC GLAUCOMA
 BASIC PRINCIPLES :
each surgical intervention MAY have
accompanying or potential future
complication

6. APPROACH TO PEDIATRIC GLAUCOMA
 BASIC PRINCIPLES :
awareness of the need for timely diagnosis
and appropriate treatment of strabismus ,
refractive errors and amblyopia , and media
opacities ( cornea and lens )

7. APPROACH TO PEDIATRIC GLAUCOMA
 BASIC PRINCIPLES :
consider other associated condition and
diseases ( e.g. retinoblastoma , cataract in
rubella , corneal decompensation in aniridia..)

8. APPROACH TO PEDIATRIC GLAUCOMA
 BASIC PRINCIPLES :
pediatric glaucoma is a FAMILY disease

9. APPROACH TO PEDIATRIC GLAUCOMA
 Causes of childhood
glaucoma :

10. APPROACH TO PEDIATRIC GLAUCOMA
 Causes of childhood
glaucoma :
- primary
-associated with
systemic conditions
-secondary

11. APPROACH TO PEDIATRIC GLAUCOMA
 primary

12. APPROACH TO PEDIATRIC GLAUCOMA
 Associated with
systemic conditions

13. APPROACH TO PEDIATRIC GLAUCOMA
 Secondary
INFANTILE APHAKIC
GLAUCOMA……

14. APPROACH TO PEDIATRIC GLAUCOMA
Examination Under Anesthesia..
( EUA )

15. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under anesthesia UAE

16. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under anesthesia UAE
Equipment for UAE :

17. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under anesthesia UAE
Goals :
diagnose
classify
identify the etiology
set a baseline
document
monitor

18. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under anesthesia UAE
Seven steps :
1-Cornea and Anterior segment
2-Intra Ocular Pressure
3-Posterior Segment
4-Gonioscopy
5-Supplemental Examination
6-Diagnostic Paradigm
7-Summary

19. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Cornea and Anterior
Segment

20. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Intra Ocular Pressure
( IOP )

21. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Intra Ocular Pressure
( IOP )

22. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Posterior Segment

23. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Gonioscopy

24. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Gonioscopy

25. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Gonioscopy

26. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Supplemental
Examination
( axial length )

27. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Supplemental
Examination
( axial length )

28. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Supplemental
Examination
( axial length )

29. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Supplemental
Examination
( axial length )

30. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Supplemental
Examination
( axial length )

31. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
Diagnostic Paradigm

32. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
EUA Summary

33. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
EUA Summary

34. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
EUA Summary

35. APPROACH TO PEDIATRIC GLAUCOMA
 Examination under
anesthesia UAE
EUA Summary

36. APPROACH TO PEDIATRIC GLAUCOMA
 Medical treatment of the pediatric glaucoma

37. APPROACH TO PEDIATRIC GLAUCOMA
 Surgical treatment of the pediatric glaucoma
- goniotomy
- trabeculotomy
- trabeculectomy
- trabeculectomy-otomy
- tube implants
- cyclodestructive procedures

38. APPROACH TO PEDIATRIC GLAUCOMA
 Goniotomy

39. APPROACH TO PEDIATRIC GLAUCOMA
 Trabeculotomy

40. APPROACH TO PEDIATRIC GLAUCOMA
 Trabeculotomy

41. APPROACH TO PEDIATRIC GLAUCOMA
 Trabeculotomy

42. APPROACH TO PEDIATRIC GLAUCOMA
 Trabeculectomy

43. APPROACH TO PEDIATRIC GLAUCOMA
 Tube implants

44. APPROACH TO PEDIATRIC GLAUCOMA
 Cyclodestructive
procedures

45. APPROACH TO PEDIATRIC GLAUCOMA
 LongTerm Resource Planning :
- Ophthalmologists
- Instruments and supplies
- Parents and health planners
- Doctors , nurses , primary health workers
- Anesthesia for pediatric patients

46. APPROACH TO PEDIATRIC
GLAUCOMA
DR Saladin Mugharbel