Abstract Background Primary congenital glaucoma (PCG) is an uncommon but serious cause of childhood visual loss. In African settings, children often present late, with advanced disease. However, the evidence on treatment outcomes and barriers to care has not yet been comprehensively mapped. Methods We searched PubMed, Scopus, Google Scholar, EMBASE, Web of Science, African Journals Online, and African Index Medicus for English-language studies published between January 2011 and January 2026. Eligible studies reported treatment approaches, outcomes, complications, or barriers to care for children with PCG in Africa. Findings were synthesized narratively. Results Ten studies involving 746 eyes from Tanzania, Ghana, Nigeria, Senegal, Ethiopia, Egypt, and Tunisia were included. Most were retrospective single-center studies. Mean age at presentation, where reported, ranged from 4.8 ± 3.6 months in Nigeria to 2.7 years in Ethiopia, while mean age at diagnosis was reported as 4.4 months in Ghana and 19 months in Tanzania. Mean age at surgery was reported as 5.2 ± 2.9 months in the Nile Delta cohort in Egypt, 5.9 months in Tunisia, and 8.1 ± 5.9 months in Nigeria. Bilateral disease, corneal edema, enlarged corneal diameters, and raised intraocular pressure were commonly reported. Surgery was the main reported treatment approach. Combined trabeculotomy-trabeculectomy was commonly used in more advanced cases, while angle procedures were used when corneal clarity allowed. Postoperative intraocular pressure reduction was reported, and short- to medium-term surgical success ranged from 72.7% to 91.6%. Longer follow-up showed a decline from 91.6% at 1 year to 54.3% at 10 years in Tunisia. Visual outcomes were less consistent, and poor follow-up, delayed referral, limited surgical infrastructure, and cost were frequently reported barriers. Conclusion PCG in African children remains marked by delayed diagnosis, advanced disease at presentation, and barriers to care. Improving outcomes will likely require earlier recognition, stronger referral and follow-up systems, wider access to pediatric glaucoma expertise, and more robust multicenter prospective research.
Bob-Ume et al. (Mon,) studied this question.