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Chapter-26 Surgical Management of Primary Infantile Glaucoma

BOOK TITLE: Surgical Techniques in Ophthalmology (Pediatric Ophthalmic Surgery)

Author
1. Freitas Maria Da Leiz
ISBN
9789350251485
DOI
10.5005/jp/books/11282_26
Edition
1/e
Publishing Year
2011
Pages
12
Author Affiliations
1. R Crasto, 708-4050-243, Porto, Portugal
Chapter keywords

Abstract

The term developmental glaucoma includes primary congenital glaucoma and glaucoma associated with other developmental anomalies, either ocular or systemic. Primary congenital or infantile glaucoma is evident either at birth or within the first few years of life. Secondary infantile glaucoma is associated with inflammatory, neoplastic, hamartomatous, metabolic, or other congenital abnormalities of the eye. Developmental glaucoma occurs in about 1 in 10,000 live births and primary congenital or infantile glaucoma is believed to occur 1 in 30,000 births. Primary infantile glaucoma remains unproven; it is generally related to an iridocorneal angle malformation, with an obstacle to aqueous humor outflow. Cellular or membranous abnormality in the trabecular meshwork is the primary pathologic mechanism. Hoskins et al. have suggested an anatomic classification for developmental glaucoma. Diagnosis of infantile glaucoma depends on careful clinical evaluation, including IOP measurement, measurement of corneal diameter, gonioscopy, measurement of axial length by ultrasonography and retinoscopy, and ophthalmoscopy. The characteristic finding are epiphora, photophobia and blepharospasm, corneal edema, tears in Descemet’s membrane called Haab’s striae may occur. Medications have limited long-term value for infantile glaucoma in most cases. In children less than 2 to 3 years of age goniotomy or trabeculectomy are recommended surgical procedures. Combined Trabeculectomy—Trabeculectomy is also done. Cyclocryotherapy has been used as therapy. Patients with infantile glaucoma require follow-up examinations for life. It appears that the surgical prognosis for patients with infantile glaucoma is best when the onset of the disease occurs between the first and the twenty-fourth month of life.

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