الفهرس 
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Abstract
Congenital glaucoma is a major cause of visually handicapped children. Early diagnosis and treatment are essential in improving the visual preservation in these patients. Primary congenital glaucoma (PCG) is different from glaucomas that occur in adults. The patient does not present with symptoms, but rather the parents observe signs that alert them. Recent genetic studies done on families in which there is more than one affected individual showed that more than one gene is implicated for the disease (i.e heterogenicity) the main gene has been mapped to the short arm of chromosome two, and another gene has been mapped to the short arm of chromosome six. It is generally agreed that the intraocular pressure elevation in primary congenital glaucoma is due to abnormal development of the anterior chamber angle, which leads to obstruction of the aqueous outflow. However, there is no universal agreement about the nature of this developmental alteration. Many theories had been postulated: Incomplete atrophy of mesodermal tissue in the angle, impermeable membrane covering the angle, incomplete cleavage with a high insertion of the iris which may compress the trabecular beams, and developmental arrest of the anterior chamber angle tissue derived from the neural crest cells. Before Barkan introduced goniotomy in 1939 the prognosis of primary congenital glaucoma was poor. Incising the angle of the anterior chamber resulted in normalization of IOP, thus it was assumed that there is a membrane could not be demonstrated histologically, and the pathogenesis is still controversial. Surgery is essentially the only line of treatment and long term medical therapy is reserved for hopeless cases which have exhausted all surgical options. Goniotomy or trabeculotomy is the treatment of choice. Goniotomy is recommended in children younger than 3 years of age when the cornea is clear. Trabeculotomy is recommended when corneal clouding prevent adequate visualization of the angle or in children older than 3 years of age. Trabeculectomy is indicated in the advanced cases or failure of goniotomy and trabeculotomy to control the disease, it is often successful, particularly when combined with adjunctive antimetabolites. Combined trabeculotomy and trabeculectomy have a favarable outcome but after 2 years the advantages of this procedure over trabeculotomy or trabeculectomy was not satistically significant according to life table analysis. Glaucoma drainage implants are useful when other surgical treatment have a poor prognosis for success, prior conventional surgery fails, or when significant conjunctival scarring precludes filtration surgery. Endoscopically controlled intraocular surgery has been evolving rapidly since the introduction of thinner endoprobes with increasing resolving power and higher image quality.