Different genetic lici reported to contribute to the susceptibility of eyes to primary open angle glaucoma/normal transient glaucoma have been identified and at least 15 1oci, from juvenile open angle glaucoma gent to glaucoma I open angle gene, have been have been linked to primary open angle glaucoma Thus, it is reasonable to examine the association between primary open angle glaucoma and insulin like growth factor II gene polymorphisms and to investigate effect of polymorphism on the type of treatment The present study included 80 cases with primary open, angle glaucoma and 40 age and sex-matched controls cases subdivided into two equal groups: The first included 40 cases that were medically controlled and the second included 40 cases that were surgically treated. Ali subjects had full ophthalmologic examination and were investigated for IGF-II polymorphism. GG was reported in 10, 7.5 and 45% in subgroup A, B and control groups, respectively, while GA was reported in 50.0, 75.0 and 32.5% un the same order and finally AA was reported in 40, 35.0 and 22.5% in the same order; with significant increase of GG and decrease of both GA and A-A in control group when compared to either of study subgroups A or B. At the same time, there was no significant difference between subgroups A or B as regard Genotyping. The odds ratio was significantly different between study and control groups. The odds ratio of G/G homozygote is 0.31 (95%CI= 0.12-0.76).IGF-II gene polymorphism is associated with POAG. The most reasonable mechanism may be linked to oxidative stress No effect of IGF-II Polymorphism on treatment was observed.