Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 3102
  • Home
  • Print this page
  • Email this page


 
   Table of Contents      
ARTICLE
Year : 1983  |  Volume : 31  |  Issue : 5  |  Page : 619-622

Clinical presentation of congenital glaucoma


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., Ansari Nagar, New Delhi, India

Correspondence Address:
H C Agarwal
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., Ansari Nagar, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 6671776

Rights and PermissionsRights and Permissions

How to cite this article:
Agarwal H C, Sood N N, Kalra B R. Clinical presentation of congenital glaucoma. Indian J Ophthalmol 1983;31:619-22

How to cite this URL:
Agarwal H C, Sood N N, Kalra B R. Clinical presentation of congenital glaucoma. Indian J Ophthalmol [serial online] 1983 [cited 2019 Aug 20];31:619-22. Available from: http://www.ijo.in/text.asp?1983/31/5/619/36607

Table 9

Click here to view
Table 9

Click here to view
Table 8

Click here to view
Table 8

Click here to view
Table 7

Click here to view
Table 7

Click here to view
Table 6

Click here to view
Table 6

Click here to view
Table 5

Click here to view
Table 5

Click here to view
Table 4

Click here to view
Table 4

Click here to view
Table 3

Click here to view
Table 3

Click here to view
Table 2

Click here to view
Table 2

Click here to view
Table 1

Click here to view
Table 1

Click here to view
Congenital glaucoma being a relatively rare condition poses numerous problems in the early diagnosis. The accurate measurement of intra­ocular pressure and interpretation of gonioscopic findings are not entirely clear. All the personnel dealing with infants and children are not fully aware of the seriousness of the problem. Delay in diagnosis further adds to the problem of management of such cases. The purpose of this communication is to highlight the various problems encountered in our cases of congenital glaucoma. As far as we are aware no large series on congenital glaucoma from India have been published.


  Materials and Methods Top


A total of sixty four cases (forty one males and twenty three females) admitted from January 1974 to March 1981 have been included in this study. There was involvement of both eyes in forty one, right eye twelve and left eye eleven respectively. All children were examined under standardized conditions of general and­ esthesia. The examination included anterior segment tonometry with both schiotz tonometer and Perkin's hand held applanation tonometer, measurement of corneal diameter, fundoscopy, gonioscopy with Koeppe's direct gonioscope. Ultrasonography was done wherever indi­cated. For follow up similar procedures was adopted.


  Observations Top


The age of onset of symptoms and the age of first presentation to an ophthalmologist is given in [Table - 1]. The clinical features are given in [Table - 2],[Table - 3],[Table - 4],[Table - 5],[Table - 6],[Table - 7],[Table - 8].

The gonioscopic examination, wherever possible revealed presence of prominent iris processes extending over trabecular meshwork, anterior schwalbe's line to varying extents. In some cases there was heavy pigmentation of the angle structures with clumps of pigmented masses in the angle region obstructing the view of angle structures.


  Discussion Top


It is a rare condition constituting 0.05% of ophthalmic cases attending the out-patient at this Centre, 0.01% Lehrfeld & Reber (1937) 0.08% Anderson (1939). The disease was found to affect predominently males (64.1%) and 64.1% of cases had bilateral involvement. Non­awareness of such a serious condition among the obstetrician, paediatricians, general practitioners and also carelessness on the part of the parents produced a lapse of 6 months or more before a larger number of these patients were brought to this hospital. Although 8.0% had their onset of symptoms within first four weeks of birth, they first came to the hospital nearly 6-8 months later. By then serious corneal changes had developed. [Table - 9] highlights the early onset and later presentations in Indian children.

The most common presenting symptom in our cases was the presence of corneal opacity. It was observed that more than 80% of these cases had varied grades of corneal opacities such as peripheral, central or diffuse. The slit lamp examination revealed epithelial oedema separation of stromal lamellae, descemet's folds and ruptures. Endothelial changes were present in 22.9%. The presence of corneal opacities and oedema posed a problem in measurement of corneal diameter, gonioscopy, fundus evaluation and recording of intraocular pressure.

The second most important mode of presentation was enlargement of globe. Nearly 50% of eyes had developed corneal diameter of more than 13 mm., when measured "white to white" in horizontal meridian.

In a large number of cases associated corneal opacity hampered the view of the angle with direct gonioscope.

The evaluation of fundus changes in 46.7% of eyes was not possible due to associated corneal changes. However, where possible, cup-disc diameter of 0.3 was found in 24.8% of eyes & above 0.3 in 28.5% of eyes. The fundus changes in children appear early & are reversible if intraocular pressure is controlled in early stages.

The associated ocular anomalies e.g. congenital cataract 13.3%, nystagmus, 9.5% Reiger's anomaly 4.8% & Peter's anomaly 1.0% may worsen the final visual outcome in these patients. Also the associated systemic anomalies e.g. patent ductus arteriosus (2 cases) and hydocephalus (1 case) form a problem from anaesthesia point of view as these patients require frequent examination under general anaesthesia.

The awareness of this rare condition among the obstetricians, paediatricians & practitioners both general & ophthalmic is essential. This willl not only avoid the various problems which develop due to delay in the diagnosis of congenital glaucoma but the permanent visual impairment can be prevented.


  Summary Top


A study of 64 cases of primary congenital glaucoma has been described.

The most remarkable features in these cases were late presentation although the onset of symptoms were present quite early. The delay in the diagnosis of congenital glaucoma lead to the enlargement of corneal diameter over 13 mm., development of corneal changes and fundus changes. This made the visual prognosis poor.

This calls for awareness among the obstetricians, paediatricians and practioners for early detection of this rare condition, so that these patients can be referred to institutions for early management before gross damage to eye occurs[2].

 
  References Top

1.
Anderson, Hydrophthalmia or congenital glau­coma, Camb, 1939.  Back to cited text no. 1
    
2.
Lehrfeld & Reber, Arch. Ophthal., 18: 712, 1937.  Back to cited text no. 2
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9]


This article has been cited by
1 Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14 mm or more
Mandal, A.K., Matalia, J.H., Nutheti, R., Krishnaiah, S.
Eye. 2006; 20(2): 135-143
[Pubmed]
2 Outcome of surgery on infants younger than 1 month with congenital glaucoma
Mandal, A.K., Gothwal, V.K., Bagga, H., Nutheti, R., Mansoori, T.
Ophthalmology. 2003; 110(10): 1909-1915
[Pubmed]
3 Surgical results of combined trabeculotomy-trabeculectomy for developmental glaucoma
Mandal, A.K., Naduvilath, T.J., Jayagandan, A.
Ophthalmology. 1998; 105(6): 974-982
[Pubmed]
4 Mitomycin-C in congenital glaucoma
Agarwal, H.C., Sood, N.N., Sihota, R., Sanga, L., Honavar, S.G.
Ophthalmic Surgery and Lasers. 1997; 28(12): 979-985
[Pubmed]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Materials and Me...
Observations
Discussion
Summary
References
Article Tables

 Article Access Statistics
    Viewed1912    
    Printed53    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    
    Cited by others 4    

Recommend this journal