Congenital Glaucoma: from the diagnosis up to the surgery. About a case

• Published in: Acta ophthalmologica (Oxford, England) Vol. 89; no. s248
• Main Authors: IBANEZ, J, PEREZ GARCIA, D, REMON, L, JIMENEZ DEL RIO, B, PEIRO, C, CABEZON, L, RAMIRO, P, CRISTOBAL, JA
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-09-2011; Wiley Subscription Services, Inc
• Subjects: Anesthesia; Cornea; Diagnosis; Edema; Exploration; Eye; Glaucoma; Medical treatment; Patients; Surgery; Timolol; Ultrasound
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2011.225.x

Purpose The surgical treatment is, at present, universally accepted as treatment of choice in the congenital primary glaucoma. However, sometimes at the time of diagnosis, the conditions of the eye disable to carry out the surgery in safety conditions.
Methods We present the case of a baby of 8 months, who was referred to our department for pain and corneous opaqueness of 48 hours of evolution. Exploration shows the presence of edematous cornea, with increase of the horizontal diameter (12 mm, opposite to 10 mm of the contralateral eye). With the possible diagnostic of congenital glaucoma, ultrasound scan was performed to confirm the increase in the axial length, and determination of the intraocular pressure(Perkins tonometry and Tono‐Pen, under topical anesthesia), which confirmed numbers abnormally high (38 and 42 mmHg respectively).
Results Confirmed the diagnosis, and given the inability to carry out the goniotomy due to the corneal edema, began treatment with fixed combination dorzolamida/timolol 2 times a day for 5 days. The improvement of the corneous condition after the guideline of medical treatment, allowed the angular exploration and the surgery in safety conditions 7 days later.
Conclusion In the managing of the congenital glaucoma, given the special characteristics of the patient, in many cases is necessary to delay the surgery in time. It is important to perform a thorough ophthalmological and systemic exploration in newborn patients to optimize the conditions of the eye before the surgery, allowing that this one should carry out, and making it less difficult, as far as possible.