Long-term outcomes. J AAPOS. 2008;12(1):33–39.

Wells AP, Cordeiro MF, Bunce C, Khaw PT. Cystic bleb formation and related complications in limbusversus fornix-based conjunctival flaps in pediatric and young adult trabeculectomy with mitomycin C. Ophthalmology. 2003;110(11):2192– 2197.

Medical Therapy

Generally, medical therapy for childhood glaucoma has lower success rates and greater risks than that for adult glaucomas. Medical therapy, however, serves several important roles in preoperative, postoperative, and long-term management, particularly in childhood glaucoma other than PCG.

Because of the greater dosage per body weight and the limited number of controlled clinical trials in children, medical therapy for pediatric glaucoma carries unique risks (Table 22-3). Although punctal occlusion may be used to reduce systemic absorption of topical medications, it may be impractical in many young children. Limiting the frequency of eyedrop administration in young children may enhance adherence.

Table 22-3

Topical medications

Topical β-blocker therapy may reduce IOP by 20%–30%. The major risks of this therapy are respiratory distress caused by apnea or bronchospasm and bradycardia, which occur mostly in small infants and in children with a history of bronchospasm. Betaxolol is a cardioselective β1-adrenergic antagonist, but its pressure-lowering effect is less than that of nonselective agents.

Topical carbonic anhydrase inhibitors (CAIs) are effective in children, but they produce a smaller reduction in IOP (<15%) than do β-blockers. Corneal edema is a risk of topical CAIs; they should be