Ординатура / Офтальмология / Английские материалы / The Glaucomas Volume 1 Pediatric Glaucomas_Sampaolesi, Zarate_2009
.pdf
272 Chapter 17 Optic Nerve
Fig. 17.75 HRT, right eye. Visual field stage III with conventional perimetry
Clinical Cases |
273 |
Fig. 17.76 HRT, left eye. Visual field with conventional perimetry, stage I
274 Chapter 17 Optic Nerve
Fig. 17.77 Echometry of the right eye
Fig. 17.78 Echometry of the left eye
Clinical Cases |
275 |
Case 8:
Bilateral Refractory Congenital Glaucoma
18 years of follow up
At the age of 1 month, this male child presented lacrimation, photophobia, and corneal edema. The child was attended and operated in his city of birth. The mother and the aunt had keratoconus (Figs. 17.79, 17.80, 17.81, 17.82, 17.83, 17.84, 17.85).
In conclusion, we repeat that the ophthalmologist should not be discouraged by failure in surgeries and severe complications. The first two surgeries performed (goniotomies) were not successful in this child. The second surgery done in his right eye (trabeculo-
Right eye
tomy) also failed. At 7 months, he was sent to us and we performed a combined surgery in the right eye (trabeculotomy and trabeculectomy) and trabeculotomy in the left eye. This third surgery in the right eye and the second in the left eye have regulated the pressure to date. Since the right eye had a tear in the Descemet membrane passing trough the pupil, we made a perforating corneal graft, because amblyopia and strabismus were starting. The first corneal graft was complicated by an abscess. We performed a second perforating corneal graft and then a refractive surgery. Today he is an outstanding 18-year-old student with no strabismus and a good bilateral visual field.
Left eye
IOP |
30 mmHg |
32 mmHg |
Surgery 1 |
Goniotomy |
Goniotomy (6 months) |
IOP |
20 mmHg |
10 mmHg |
Surgery 2 |
Trabeculotomy temporal |
|
1991: surgeon who operated the child earlier sent him to me for treatment |
|
|
Axial length |
23.49 mm |
23.70 mm |
IOP |
30 mmHg |
22 mmHg |
Corneal diameter |
14 mm |
13.5 mm |
Chamber angle |
Invisible because of corneal edema. Congential glaucoma type I, Haabs lines |
|
Surgery 3 |
Combined surgery Trabeculotomy + Trabeculectomy (6 o’ clock) |
Trabeculotomy (12 o’ clock) |
IOP (8 months) |
15 mmHg |
10 mmHg |
|
Divergent squint |
Divergent squint |
Surgery 4 (9.5 months) |
First corneal graft |
|
Bronchitis (11 months) |
Pneumococcus, corneal abscess |
|
Surgery 5 (16 months) |
Second corneal graft |
|
Surgery 6 (astigmatism) |
Incisional refractive surgery |
276 |
Chapter 17 Optic Nerve |
|
|
|
|
Right eye |
Left eye |
|
|
Squint disappears with occlusion and orthoptic exercises |
|
|
IOP (2 years) |
14 mmHg |
11 mmHg |
|
DPC (10 years) |
Normal |
Normal |
|
Axial length (15 years) |
23.49 mm |
23.79 mm |
|
Refraction |
Sph –8, cil –3 180° |
Sph –0.50, cil –2.75 10° |
|
Visual acuity |
20/200 |
20/30 |
|
Optic nerve |
Megalopapilla |
Normal |
|
|
(disc area: 3.404 m3) |
|
|
Visual field |
|
|
|
Conventional perimetry |
Stage III |
Normal |
|
Nonconventional perimetry |
Stage III |
Normal |
Clinical Cases |
277 |
Fig. 17.79 Chart of intraocular pressure with the different intraocular pressures with red dots, right eye, with blue dots, left eye over 15 years
Fig. 17.80 Chart of axial length with the different values; right eye, red, left eye, blue, and surgeries done
278 Chapter 17 Optic Nerve
Fig. 17.81 Goniophotograph of the left eye after trabeculotomy
Fig. 17.82 Right eye ruptures in the Descemet membrane (Haab´lines) and two iridectomiess
Clinical Cases |
279 |
Fig. 17.83 HRT in right and left eyes, which shows that there is no progression
280 Chapter 17 Optic Nerve
Fig. 17.84 Visual field in right and left eyes with conventional and nonconventional perimetry with Glaucoma Staging System
Clinical Cases |
281 |
Fig. 17.85 Right and left eye of case no. 8. On the right, the patient, on the left, his sister. Below, the patient today as an 18-year-old student and playing hockey