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The Developmental Glaucomas
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Carlo E. Traverso, Alessandro Bagnis
Penlight exam of the cornea may reveal gross abnormalities, such as an opacity or an irregular light reflex indicative of corneal edema. Slit-lamp examination (Figure 13.40) permits a more detailed examination of the cornea and other anterior segment structures. Corneal findings include epithelial and stromal edema and breaks in Descemet’s membrane. When Descemet’s membrane is overstretched by pressure-induced corneal enlargement, linear breaks may occur. These breaks can result in acute stromal edema with accompanying photophobia (Figure 13.41). Because both edges of the ruptured membrane roll up, when the cornea eventually clears, a typical pattern of rail-like defect is evident at the level of Descemet’s membrane. Breaks occurring in congenital glaucoma are known as Haab’s striae and are characterized by a horizontal orientation or a location parallel to the limbus (Figure 13.42). They are usually seen in the setting of elevated intraocular pressure and enlarged corneal diameter (greater than 10.5 mm in the horizontal meridian in the newborn infant). On the other hand, breaks due to birth trauma tend to run in any direction and are accompanied by normal intraocular pressure and normal corneal diameters (Figure 13.43). Iris abnormalities, such as atrophy and abnormal vessels, are noted, and the anterior chamber depth is assessed (Figure 13.44). Lens clarity and position are noted as well as any evidence of phakodinesis.
Illuminated Microcatheter Passage Assisted Circumferential Trabeculotomy and Trabeculectomy (IMPACTT): An improved surgical procedure for Primary Congenital Glaucoma
Published in Seminars in Ophthalmology, 2022
The patient was a 4-month-old child, product of a normal pregnancy and his birth weight was 3 kg. The parents noticed gradual enlargement of the eyes with intolerance to light and tearing from the eyes since the second months of birth. They consulted a general ophthalmologist who referred the child to us with the provisional diagnosis of congenital glaucoma. His physical examination was unremarkable. Examination under anesthesia revealed horizontal corneal diameter of 13.5 mm with diffuse corneal edema with multiple Haab’s striae in both eyes. His intraocular pressures were 36 mm Hg in both eyes and the lenses were clear. Gonioscopic view was hazy, but flat insertion of the iris over the poorly developed trabecular meshwork could be appreciated. Indirect ophthalmoscopy revealed asymmetric cupping of the optic of the optic nerves (0.6 OD and 0.4 OS). The posterior pole of both the eyes was otherwise normal with an incomplete view of the fundus. On ultrasound B-scan, both the eyes showed anechoic posterior segment. With this history and clinical findings, a diagnosis of bilateral primary congenital glaucoma was established, and the child underwent surgical intervention.