|Year : 1982 | Volume
| Issue : 4 | Page : 311-313
Management of secondary glaucoma in aniridia
A Panda, NN Sood, HC Agarwal
Dr. Rajendra Prasad Center for Ophthalmic Sciences, A.I.I.M.S., New Delhi, India
Dr. Rajendra Prasad Center for Ophthalmic Sciences, A.I.I.M.S., New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Panda A, Sood N N, Agarwal H C. Management of secondary glaucoma in aniridia. Indian J Ophthalmol 1982;30:311-3
The association of raised intraocular pressure in cases of congenital anit idia is very well known 1,2,3,4,5. The condition is intractable and does not respond well to conventional medical and surgical therapy of glaucoma.
| Material|| |
Sixteen cases of congenital aniridia attended the glaucoma clinic during last 4-1/2 years. Fifteen were bilateral while one was unilateral.
| Clinical findings|| |
The associated anomalies and refractive errors are listed in [Table - 1][Table - 2].
A gonioscopic examination, with Goldman Gonioscope or Koppes lans was performed.
There was presence of peripheral stumps of iris. The stumps of iris were adherent to the trabecular meshwork, which varied from isolated synaechiae to broad basal peripheral anterior synaechiae. The trabecular meshwork showed marked pigmentation. The gonioscopic findings in non-glaucomatous eyes did not reveal any abnormalities.
[Table - 3]
| Management|| |
Medical-In all these eleven eyes of congenital aniridia with raised intraocular pressure, medical therapy in the form of pilocarpine eye drops 2% or 4% and/or epinephrine drop 1/2% locally and acetazolamide three times a day were tried. The local drops alone could control the intra-ocular pressure below 22mm Hg in four eyes, having basal intra-ocular pressure upto 30mm. Hg. Further, medical therapy failed to control the intra-ocular pressure in rest of the seven eyes.
| Surgical|| |
In four eyes cyclocryotherapy was tried. The procedure adopted by us was;a single freeze thaw cycle all along 360° at the temperature of 80°C, with 50 seconds freezing and 10 secondsthawing. The adjacent applications were having 1 /3 overlap. Twelve such applications were required for each eye. The intra-ocular pressure remained controlled till a follow up period of 1 1/2 years in all the four eyes.
In one eye trabeculectomy was performed, The intra-ocular pressure remained below 22mm. Hg. upto a period of follow up of 8 months.
In two eyes no surgical procedures were undertaken as they were asymptomatic and without perception of light.
| Discussion|| |
The absence of the iris diaphragm leads to photophobia as a rule. Nystagmus might occur and the vision is usually poor-the functional defects sometimes result in amblyopia. In the absence of other gross anomalies, the frequent occurence of low visual acuity and nystagmus may be due to the absence of fovea, A [Table - 4] shows the ocular findings in some of the reported series of aniridia.
It is reported that glaucoma usually occurs in teen age group (Frederick & Joseph)5,3; but in our cases glaucoma could be seen in the age group ranging from 3-40 years. This suggests that a rise of intra-ocular pressure can take place even in early childhood. The onset of glaucoma would depend on the rapidity of the development of angle changes. The progressively increasing adhesions between the root of the iris and trabecular meshwork leads to progressive obliteration of angle region. This in turn produces rise of intra-ocular pressure. The rise of intraocular pressure in such cases is insidious and less dramatic than in primary infantile glaucoma. It is necessary to follow up these cases right from birth to detect the rise of intraocular pressure at the earliest.
The syndrome of congenital aniridia may be composed of 4 phenotypes,
Common association of aniridia, foveal hypoplasia, nystagmus, corneal pennus and secondary glaucoma.
Only iris defect with normal visual acuity. With mental retardation.
Associated with Wilm's Tumor.
This classification is important for management point of view. It is obvious that our cases belong to the category I.
The management of these cases is always difficult and frustrating. Practically every method of treatment known to control the raised intra-ocular pressure has been advocated by atleast one author and subsequently condemned by the other.
Both medical and surgical therapy seems to be equally ineffective. Medical treatment with miotics, epinephrine and carbonic anhydrase inhibitors are often helpful, temporarily though, in controlling the glaucoma, but in a majority of patients medical treatment eventually proves inadequate. Increasing abnormalities in the angle reduced the effectiveness of medical treatment (Grant) 6.
The inadequacy of the various types of glaucoma surgery is also apparents 6,7,3,5
The value of cyclocryotherapy in treatment of raised intra occular pressure in cases of congenital aniridia has not been adequately reported. Grant Morton carried out cyclocryotherapy in two eyes of two different patients. In one eye the procedure appeared helpful while in the other eye it produced profound hypotony.
| Summary|| |
Thirty one eyes of sixteen cases of congenital aniridia with various associated ocular abnormalities have been reported. In eleven eyes the intraocular pressure was found to be high. The onset of glaucoma was found to be earlier than reported in the literature. The intra-ocular pressure could be controlled by medical therapy in six eyes, by trabeculectomy in one eye and by cyclocryotherapy in four eyes. The period of follow up of over 1 year4-1/2 years was uneventful and the tension remained controlled.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]