Ординатура / Офтальмология / Английские материалы / The Glaucomas Volume 1 Pediatric Glaucomas_Sampaolesi, Zarate_2009

Case 3:

Congenital glaucoma Type I (Unilateral)

35 years of follow up

Family history: This female child, aged 8 months, was treated until 5 months of age for conjunctivitis. At 2 weeks, the left eye was seen to be much larger. She was examined under general anesthesia (by an another colleague) and not operated. Surgery was done at the age of 8 months. She was followed up for 25 years (Figs. 17.59, 17.60).

This case is very useful because it shows several things:

1.That one frequent error of the pediatrician is to treat a glaucoma as conjunctivitis.

2.One error of the ophthalmologist is to make an examination with general anesthetic and think that it is a case of normal child, because they do not know the normal values of ocular pressure and axial length.

3.Congenital glaucoma is like acute glaucoma. As Schaeffer said, when it is diagnosed under general anaesthetic for the exam, it should be operated immediately.

4.The 6-month delay produces a small lesion in the optic nerve that translates into a visual acuity of 0.9 20/60 in the operated eye vs 1.0 20/20 in the normal eye.

5.Normal frequency doubling perimetry and even more the Pulsar reveal a Bjerrum scotoma in the operated eye (Fig. 17.60).

Case 5:

Congenital Glaucoma Type I (Bilateral)

27 years of follow up

This is the second case of all the congenital glaucomas I have seen that also presented congenital glaucoma first in the left eye, while the right eye had a normal echometry and no symptoms. The left eye had three Haab lines just around the pupil. The chamber angle in the left eye was type I and trabeculotomy was performed. At the first postsurgical examination at 4 months of age, the echometry in the left eye decreased from 21.15 mm to 20.53 mm (due to surgery), while the right eye had an intraocular pressure of 10 mmHg, the echometry had increased from 20.19 to 21.79 mm.

When the patient was 7 months old, the echometry in the left eye remained 20.19 mm, whereas in the right eye was 22.20 mm and the intraocular pressure was 26 mmHg. Trabeculotomy was performed in the right eye as well.

The patient was followed up for 27 years. His visual acuity in the right eye is 20/20 and in the left eye is 20/30 (the lower visual acuity is due to the Haab lines in the cornea). The visual fields and the confocal tomographies are normal in both eyes, with binocular vision.

He is now a medical doctor specialized in neurology (Figs. 17.64, 17.65, 17.66, 17.67).