Primary congenital glaucoma : a case report /
Jose Edwardo G. De Guzman, Manolito R. Reyes and Miriam Louella D. Fermin.
- Fairview, Quezon City, Department of Ophthalmology, FEU-NRMF, 2022.
- 29 pages: illustrations, tables; (in folder) with flash drive (soft copy).
Includes appendices and bibliographical references.
Abstract: This is a case of a 9-month-old female who presented with opacity of the right eye associated with enlargement of both eyes and intolerance to light. Patient initially consulted a pediatrician which then referred her to a pediatric ophthalmologist where she was diagnosed with bilateral congenital glaucoma and was prescribed with topical anti-glaucoma medications. Patient was also referred to a glaucoma specialist at our institution. Initial consult showed that both eyes were able to fixate and follow. External exam revealed presence of buphthalmos on both eyes and corneal opacity on the right eye. On digital tonometry, both eyes were found to be hard. Patient was advised to undergo examination under anesthesia (EUA). During examination, Intraocular pressure (IOP) was 25.6 mmHg on right eye and 22 mmHg on the left eye. On external eye exam the right eye showed presence of breaks on the Descemet's membrane (Haab's striae) and clear cornea on the left eye. Corneal Diameter was noted 12.5mm (V) x 12mm (H) on the right eye and 13.5 mm (V) x 13mm (H). Refraction revealed myopic component of both eyes. Indirect ophthalmoscopy revealed presence red orange reflex, 2:3 AVR with no hemorrhages or exudates on both eyes, CDR 0.5 on the right eye and 0.6 on the left eye. Considering the patient's history and our clinical findings we were able to confirm our working impression of Primary congenital glaucoma (PCG) of both eyes. Hence, patient underwent Ahmed valve placement on the right eye and Goniotomy on the left eye. 3 weeks postoperatively, there was recurrence of high IOP of both eyes. Tropical and Oral anti-glaucoma medications were added but persistent increase in IOP on the left eye prompted a second examination under anesthesia with possible glaucoma drainage device implantation. During the second examination, IOP was taken with the reading of 17.6 mmHg on the right eye and 31.5 mmHg on the left eye. Anterior segment examination revealed Haab's striae on the right eye and clear cornea on the left eye. Corneal diameter on the right eye measured 13.5 mm by 14.5mm by 14 mm on the left eye. Refraction was done which was identical with the first EUA. Indirect ophthalmoscopy revealed presence red orange reflex, 2:3 AVR with no hemorrhages or exudates on both eyes, CDR 0.6 on the right eye and 0.7 on the left eye. Due to persistent elevated IOP on the left eye, patient was subjected to Ahmed valve placement on the left eye. Considering the clinical history and ocular examination, our final impression was primary congenital glaucoma, an autosomal recessive disease. Patient was then referred to an ocular geneticist for further investigation ang genetic counseling, where a PCG panel was requested.