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

Case 6:

Refractory Bilateral Congenital Glaucoma

Follow up of 29 years

This male child was first seen at the age of 6 months and followed up for 29 years. In 1977, at the age of 4 months, the pediatrician treated him for conjunctivitis and at 5 months the mother noticed photophobia and tearing.

This is an example of refractory congenital glaucoma for which combined surgery was used from the start: trabeculotomy + trabeculectomy in the same operation, as soon as diagnosed. The patient remains with normal axial length, 20/20 vision in both eyes, normal optic nerves and visual field. He is currently 28 years of age, working in Interpol, as an agent of the Argentine Federal police where he deals with the maintenance of networks and equipment. He also plays the piano and is still studying music (Figs. 17.68, 17.69, 17.70, 17.71, 17.72).

However, the most important aspect of this case is that the patient came in with an echometry of approximately 24 mm in both eyes, but corneas 15 mm in diameter. Today, at age 28, the eyes are still normal in size and the corneas 15 mm in diameter. This is a patient presenting refractory congenital glaucoma and a pure bilateral megalocornea that is unrelated to the glaucoma.

Case 7:

Refractory Bilateral Congenital Glaucoma

This is a 5-month-old boy whose mother noted his right eye was larger beginning at the age of 3 months, and whose first diagnosis was occlusion of the lacrimal ducts. The diagnosis we reached was refractory congenital glaucoma (type II chamber angel, apparent high insertion of the iris).

This case shows how the surgeon must always reoperate when presented with an increase in the axial length after the first operation. In this case, the clinical history shows that it was necessary to operate both eyes three times, and that the right eye had to be operated even a fourth and fifth time. The echometries were then normalized, but both eyes were left with a large axial length and myopia. Numerous check-ups have been made, with the latest in 2006, 9 years after; see Figs. 17.73, 17.74, 17.75, 17.76, 17.77, 17.78 for parameters.

In conclusion, the surgeon should not be discouraged by surgical failures. We operated this patient’s right eye three times and left eye five times, achieving a grade III visual field in the right eye and grade II in the left eye, with vision of 20/60 in the right eye and 20/30 in the left despite high myopia.