Primary congenital glaucoma outcomes: lessons from 23 years of follow-up

PURPOSE

To determine in primary congenital glaucoma whether age of presentation influences surgical success, the degrees of angle surgery needed to achieve glaucoma control, and whether there are critical ages where glaucoma progresses, requiring further surgical management.

DESIGN

Retrospective cohort study.

METHODS

The medical records of patients with primary congenital glaucoma over a 23-year period were reviewed: 192 procedures were performed on 117 eyes (70 patients). The number and age of angle procedures and final visual acuity was analyzed. Surgical success was defined as stable intraocular pressure and optic disc appearance.

RESULTS

Procedures involving 83 of the 110 eyes (75.5%) undergoing angle surgery were successful, with 2-, 4-, 6-, and 10-year success rates of 92%, 86%, 84%, and 75%, respectively. Subgroup analysis (<3 months; 3-6 months; >6 months) comparing age of diagnosis to visual outcome (<20/200, 20/200-20/40, >20/40) was significant (P = .04). The age at first operation (P = .94), the number of angle operations (P = .43), and their effect on angle surgery success was not significant. Seven of 192 operations were performed after the age of 8 years (3.6%). After the initial angle surgeries within the first year of life, the third procedure occurred at a median age of 2.4 years (interquartile ratio [IQR] 0.6-3.8 years) and the fourth procedure occurred at a median age of 5.3 years (IQR 2.5-6.1 years).

CONCLUSIONS

Children diagnosed at <3 months of age had a visual outcome of <20/200 despite successful glaucoma control. Age of presentation did not affect surgical success. A total of 78.9% of cases undergoing primary trabeculotomy were controlled with 1 operation: 4 clock hours of angle (120 degrees). Analysis of glaucoma progression suggests critical ages where further glaucoma surgery is required at around 2 and 5 years of age.

Long-term results of surgery in childhood glaucoma

PURPOSE

The aim of this study is to assess the functional results and morphological parameters in children surgically treated for glaucoma.

METHODS

Data from 43 patients and 68 eyes who were operated in our department between 1990 and 2002 were collected. This retrospective trial included primary congenital glaucoma (n=36), and secondary glaucoma (n=7) in Rieger-Axenfeld syndrome and Sturge Weber syndrome. Intraocular pressure (IOP), axial length of the eyeball, visual acuity, refractive errors and orthoptic status were analysed.

RESULTS

The age of patients at the first surgery was 6.0 +/- 5.3 months (range 0.7 to 28.0 months). The mean period of follow-up was 57.3 +/- 36.8 months (6.0-161.0). The mean number of surgical procedures performed on one eye was 2.5 +/- 2.4 procedures (1-11). The mean IOP before the first surgery was 31.0 +/- 7.9 mmHg (17.5-52.0), and was 15.0 +/- 3.9 mmHg (7.0-28.0) at the last visit. 49 eyes (72.1%) did not need any further medical treatment after the last surgical procedure. The IOP was 18 mmHg or lower without medication in 29 eyes (42.6%) after just one surgical procedure (21 trabeculotomy, 8 combined trabeculotomy/trabeculectomy with or without mitomycin-C). At the first examination, the mean axial length of the eyeball was 22.6 +/- 1.8 mm (the mean normal value at this age is 20.3 +/- 0.7 mm), and was 24.4 +/- 2.0 mm at the last visit (the mean normal value at this age is 22.2 +/- 0.6 mm). The best corrected visual acuity at the last visit was 0.25 +/- 4.6 lines; the normal range of visual acuity at this age is from 0.4 +/- 4.0 lines to 0.8 +/- 3.0 lines. Visual acuity was 0.32 or more in 53.0% of the eyes. Visual acuity was lower than 0.1 in only 15.2% of the eyes. Myopia was present in 57.4% of the eyes with a mean spherical equivalent of -6.1 +/-3.9 dioptres. 15 patients (34.9%) developed strabismus. 22 patients (51.2%) were treated with part-time occlusion. Binocular function as assessed with the Lang-1 test was positive in 17 of 30 patients (56.7%).

CONCLUSIONS

Although a good long-term IOP-control can often be achieved in childhood glaucoma, the visual acuity remains below the normal range in most cases despite close orthoptic follow-up.

Surgical outcomes with 360-degree suture trabeculotomy in poor-prognosis primary congenital glaucoma and glaucoma associated with congenital anomalies or cataract surgery

PURPOSE

To evaluate the outcomes of 360-degree suture trabeculotomy in childhood glaucoma with poor prognosis.

METHODS

A nonrandomized, retrospective chart review was performed on pediatric patients (younger than 18 years of age) treated with a 360-degree suture trabeculotomy for glaucoma. The cases were categorized into the following groups: (1) primary congenital glaucoma with birth-onset presentation accompanied by corneal clouding noted at birth, (2) primary congenital glaucoma with onset or presentation after 1 year of age, (3) primary congenital glaucoma with previous failed goniotomy surgery, (4) infantile-onset glaucoma following congenital cataract surgery, and (5) infantile-onset glaucoma with associated ocular/systemic anomalies.

RESULTS

A total of 45 eyes of 33 patients were analyzed. The mean preoperative intraocular pressure (IOP) was 34.3±6.7 mm Hg on an average of 1.5 medications. Median age at time of surgery was 7 months. Mean final IOP (median last follow-up or failure, 12 months) was 22.2±7.1 mm Hg on an average of 1.5 medications. The probability of success according to time after surgery was 87% at 6 months, 63% at 1 year, and 58% at 2 years. Kaplan-Meier analysis of Groups 1-4 versus Group 5 failed to demonstrate a statistically significant difference (p=0.13). Of 5 eyes with port wine mark-related glaucoma, 2 had a large (>50%), persistent postoperative hyphema, and concurrent vitreous hemorrhage.

CONCLUSIONS

Children with a range of ocular pathologies can be successfully treated with 360-degree suture trabeculotomy. Further evaluation of this surgical technique in primary congenital glaucoma and open-angle glaucoma following congenital cataract surgery is warranted.

Illuminated microcatheter circumferential trabeculotomy versus combined trabeculotomy-trabeculectomy for primary congenital glaucoma: a randomized controlled trial

PURPOSE

To compare outcomes of illuminated microcatheter-assisted circumferential trabeculotomy vs combined mitomycin C-augmented trabeculotomy-trabeculectomy for primary congenital glaucoma.

DESIGN

Prospective, randomized trial.

METHODS

Of the 30 patients (60 eyes) analyzed with bilateral primary congenital glaucoma aged ≤2 years, 1 eye of each patient was randomized to: illuminated microcatheter-assisted trabeculotomy (Group I) or combined trabeculotomy with trabeculectomy augmented with mitomycin C (Group II). Primary outcome measure was intraocular pressure (IOP) reduction. Categorization into absolute success (IOP ≤15 mm Hg without medication) and qualified success (IOP ≤15 mm Hg with medication) was done. Secondary outcomes included change in corneal diameter and clarity, optic disc status, refraction, need for anti-glaucoma therapy, and occurrence of complications.

RESULTS

Mean age of patients was 6.63 ± 5.74 months. IOP fell by 49.3% (22.25 ± 10.88 to 11.56 ± 3.33 mm Hg) in Group I and 46.6% in Group II (21.73 ± 8.89 to 11.60 ± 3.03 mm Hg) (P < .001 in both). At 1 year, absolute success was achieved in 86.7% (26/30) and 90.0% (27/30) in Groups I and II, respectively (P >.99) and qualified success in 93.3% (28/30) in both groups (P = 1). There was significant improvement in corneal clarity (P < .001) and cup-to-disc ratio (P ≤ .01) in both groups at 1 year. Though incidence of hyphema was significantly more in Group I (P = .0001), no vision-threatening complications occurred in either group.

CONCLUSIONS

Illuminated microcatheter-assisted circumferential trabeculotomy achieved comparable surgical outcomes to mitomycin C-augmented combined trabeculotomy-trabeculectomy and may be recommended as the initial surgical procedure for primary congenital glaucoma.

Randomized Trial on Illuminated-Microcatheter Circumferential Trabeculotomy Versus Conventional Trabeculotomy in Congenital Glaucoma

PURPOSE

To compare 1-year outcomes of illuminated microcatheter-assisted circumferential trabeculotomy (IMCT) vs conventional partial trabeculotomy (CPT) for primary congenital glaucoma (PCG).

DESIGN

Randomized clinical trial.

METHODS

Forty eyes of 31 patients with unilateral or bilateral primary congenital glaucoma aged less than 2 years were randomized to undergo IMCT (20 eyes) or CPT (20 eyes). Primary outcome measure was intraocular pressure (IOP) reduction. The success criterion was defined as IOP ≤ 12 mm Hg without and with antiglaucoma medications (absolute success and qualified success, respectively).

RESULTS

The mean age of our study population was 8.35 ± 1.2 months. The mean preoperative IOP was 24.70 ± 3.90 mm Hg in the IMCT group and 24.60 ± 3.31 mm Hg in the CPT group. Both groups were comparable with respect to preoperative IOP, corneal clarity, corneal diameter, vertical cup-to-disc ratio, and refractive error. In the IMCT group, 360-degree cannulation was achieved in 80% (16/20) of eyes. For the IMCT group and CPT groups, respectively, the absolute success rates were 80% (16/20) and 60% (12/20) (P < .001) and qualified success rates were 90% (18/20) and 70% (14/20) (P < .001). Both procedures produced a statistically significant reduction in IOP, and eyes undergoing IMCT achieved a lower IOP than CPT group eyes at 12 months follow-up (9.5 ± 2.4 mm Hg and 11.7 ± 2.1 mm Hg, respectively, P < .001).

CONCLUSION

In primary congential glaucoma, illuminated microcatheter-assisted 360-degree circumferential trabeculotomy performed better than conventional partial trabeculotomy at 1 year follow-up and resulted in significantly lower IOP measurements.

Medical and surgical outcomes in childhood glaucoma: a population-based study

INTRODUCTION

To describe the clinical and surgical outcomes among patients younger than 20 years of age diagnosed with glaucoma in a defined population during a 40-year period.

METHODS

The medical records of all patients (<20 years) diagnosed with glaucoma in Olmsted County, Minnesota, from January 1, 1965, through December 31, 2004, were retrospectively reviewed.

RESULTS

Thirty children (45 eyes) were diagnosed with various forms of glaucoma during the 40-year study period. During a mean follow-up of 12.5 years (range, 7 days to 32 years), 18 (60%) of the 30 children underwent a mean of 2.7 surgeries (range, 1 to 10), including 6 (20%) patients whose sole surgery consisted of enucleation or evisceration for a blind, painful eye. Twenty-eight (93%) of the 30 children required medical management during the follow-up period, including 14 (47%) treated before their first surgery. At the final follow-up examination, 11 (37%) had a visual acuity of 20/200 or worse. The 10-year Kaplan-Meier risk of vision decreasing less than 20/200 in all glaucoma patients was 22.7% (95% CI, 0-40.9), and patients requiring any glaucoma surgery was 68.3% (95% CI, 42.4-82.6).

CONCLUSIONS

In this population-based study of children diagnosed with glaucoma during a 40-year period, most patients required surgery, with few being successfully controlled by medications alone. A poor visual outcome or the loss of an eye was relatively common.

Penetrating keratoplasty for endothelial decompensation in eyes with buphthalmos

PURPOSE

To evaluate the prognosis and complications of penetrating keratoplasty (PKP) for corneal decompensation in eyes with buphthalmos and to analyze the risk factors for graft failure.

PATIENTS AND METHODS

Clinical records of 13 adult and three pediatric patients who underwent PKP for endothelial decompensation with a previous diagnosis of congenital glaucoma of a total of 3,663 corneal transplantations performed in our department between January 1987 and December 2001 were reviewed retrospectively. During the study period, a total of 33 PKPs was performed in 20 eyes with buphthalmos. The median age of the patients at the time of PKP was 39 years (range, 3 to 72). All patients had a history of intraocular surgery, including multiple glaucoma surgeries, cataract extraction, and PKP. The impact of pre-, intra-, and postoperative factors on graft failure and duration of graft clarity was analyzed.

RESULTS

Fifty-five percent (11/20) of the eyes received only one graft, 25% (5/20) received two, and 20% (4/20) received three grafts. During a mean follow-up of 87.2 months (range, 4.5-72), graft failure occurred in 18 of 33 grafts (54%). Seven (7/18, 39%) had immunologic graft rejection, and 11 (11/18, 61%) had nonimmunologic graft failure. At the end of the follow-up, 75% (15/20) of the eyes had clear grafts. Duration of graft clarity was found to be significantly shorter in regrafts compared with that of primary grafts (27.0 +/- 27.7 versus 56.4 +/- 41.0 months, p= 0.02). After PKP, intraocular pressure (IOP) was uncontrolled in 12 (12/33, 36%) grafts. Nine of 20 eyes (45%) required an average of 3.2 cyclodestructive procedures per eye for pharmacologically resistant elevated IOP. The final postoperative vision improved in 70% (14/20) of the eyes and the best visual acuity postoperatively (75% > or =20/400) was significantly better than the preoperative visual acuity (25% > or =20/400, p= 0.0001).

CONCLUSIONS

Endothelial decompensation due to congenital glaucoma is a very rare indication for PKP. The incidence of graft failure is high, and nonimmunologic reasons are the leading causes of graft failure in this high-risk population. Visual acuity can be significantly improved but is usually still very limited by advanced glaucomatous optic nerve damage and amblyopia. Efficient control of IOP before and after PKP is mandatory in eyes with buphthalmos to avoid graft failure and progress of glaucomatous optic nerve atrophy.

Coexistent Congenital Hereditary Endothelial Dystrophy and Congenital Glaucoma

PURPOSE

To retrospectively evaluate the coexistence of congenital glaucoma with congenital hereditary endothelial dystrophy.

METHODS

Ten infants presented to our hospital with diffuse corneal edema and bilaterally elevated intraocular pressure (IOP). These patients were diagnosed with congenital glaucoma. All patients underwent trabeculotomy with trabeculectomy for control of IOP. Although IOP was normalized in all patients, corneal edema persisted. These patients underwent penetrating keratoplasty, and the buttons were subjected to histopathologic examination.

RESULTS

The corneal grafts remained clear in all patients. The histopathologic examination of the excised corneal buttons showed diffuse stromal edema, loss of the endothelial cell layer, and thickening of the posterior non-banded portion of the Descemet membrane, suggestive of congenital hereditary endothelial dystrophy.

CONCLUSIONS

Congenital hereditary endothelial dystrophy may coexist with congenital glaucoma. This combination should be suspected where persistent and total corneal opacification fails to resolve after normalization of IOP.

Update in Genetics and Surgical Management of Primary Congenital Glaucoma

Primary congenital glaucoma (PCG) continues to be an important cause of visual impairment in children despite advances in medical and surgical treatment options. The progressive and blinding nature of the disease, together with the long lifespan of the affected population, necessitates a thorough understanding of the pathophysiology of PCG and the development of long-lasting treatment options. The first part of this review discusses the genetic features and makeup of this disorder, including all currently identified genetic loci (GLC3A, GLC3B, GLC3C and GLC3D) and relevant protein targets important for trabecular and Schlemm canal dysgenesis. These target molecules primarily include CYP1B1, LTBP2, and TEK/Tie2 proteins. Their potential roles in PCG pathogenesis are discussed with the purpose of bringing the readers up to date on the molecular genetics aspect of this disorder. Special emphasis is placed on functional implications of reported genetic mutations in the setting of PCG. The second part of the review focuses on various modifications and refinements to the traditional surgical approaches performed to treat PCG, including advances in goniotomy and trabeculotomy ab externo techniques, glaucoma drainage implant surgery and cyclodiode photocoagulation techniques that ultimately provide safer surgical approaches and more effective intraocular pressure control in the 21st century.

Unilateral esotropia after enucleation in infancy

Five patients developed esotropia in the remaining eye after unilateral enucleation in the first few weeks to months of life. Esotropia was associated with a face turn toward the opposite side and abduction nystagmus with a null point in extreme adduction. Our experience with these patients supports the reflexogenic theory for the development of a type of congenital-infantile esotropia. An intact globe-ocular muscle relationship, even in a blind eye, may have a stabilizing effect on the fellow eye in the first few weeks to months of life, and this should be considered before enucleation is done.

Transplantation of congenitally opaque corneas from eyes with exaggerated buphthalmos

We treated three eyes with marked buphthalmos and congenitally opaque corneas with cyclocryotherapy, one application in one eye and two applications in two eyes. The size of the eyes became rapidly smaller during the first two weeks postoperatively. Thereafter, corneal transplantation improved vision in each eye.

Simple glaucoma before the age of 30 years

'Juvenile glaucoma' is a meaningless term which should not be used. Glaucoma in young subjects can be hydrophthalmus, secondary or simple glaucoma. In this paper, early simple glaucoma is described in 15 patients (8 males, 7 females) below the age of 30 years, starting in some subjects already at 8 years of age. Inheritance was dominant in 6 patients. Anticipation could be shown in 2 pedigrees through 4 and 5 generations, respectively. The course of the disease was severe in 8 patients, with intraocular pressures over 40 mm Hg and/or heavy functional loss. There were usually no subjective symptoms. The chamber angles were gonioscopically normal in all patients. Miotics were effective but did not normalize the intraocular pressure. Surgical treatment is discussed.

Is viscotrabeculotomy superior to conventional trabeculotomy in the management of Egyptian infants with congenital glaucoma?

PURPOSE

The aim of this study was to assess the efficacy of viscotrabeculotomy in the management of congenital glaucoma as compared to conventional trabeculotomy, in Egyptian infants.

METHODS

This is a prospective interventional randomized comparative study in which patients with primary congenital glaucoma were randomly allocated to either group A or B; viscotrabeculotomy (VT); and trabeculotomy (T), respectively. Patients were followed up regarding intra-ocular pressure (IOP), cup/disc (C/D) ratio and horizontal corneal diameter (HCD) for 6 months. A probability value (p value) <0.05 was considered significant.

RESULTS

Twenty-one eyes in group A and 20 eyes in group B were enrolled in the study. The mean preoperative IOP was 23.5 and 24.3 mmHg in the VT and T groups, respectively. Postoperatively, IOP dropped at six months to 14.7 and 17 mmHg in the VT and T groups, respectively. That was significant in either group when compared to preoperative IOP, but not significant between both groups at the same point of comparison.

CONCLUSIONS

Both techniques were equally effective in the reduction in IOP in the management of congenital glaucoma, but viscotrabeculotomy did not appear to add more benefit to the surgical outcome than classic trabeculotomy.

Retinal detachment in eyes with congenital glaucoma

Five patients with congenital glaucoma were treated for complicated retinal detachment. All patients underwent a pars plana vitrectomy and fluid/gas or fluid/silicone exchange. The technical difficulties of operating on buphthalmic eyes are described. Due to subretinal reproliferation, corneal decompensation, and pressure elevation, the functional prognosis is still poor.

Buphthalmos following systemic steroid treatment

Corticosteroid-induced glaucoma is a well-recognized phenomenon in adults, but not children. We describe an infant who developed juvenile glaucoma with buphthalmos while receiving systemic steroid treatment. The intraocular pressure normalized several months following discontinuation of treatment.

Congenital ectopia lentis and secondary buphthalmos likely occurring as an autosomal recessive trait

A family from Turkey with congenital ectopia lentis, likely occurring as an autosomal recessive trait, is presented. No systemic disorders such as homocysteinuria, Marfan's or Weill-Marchesani's syndromes were found in any of the patients. However, all patients except one were less than 2 years old when first examined so that lens luxation must have happened very early in life. Besides almost total lack of zonular threads the patients presented anomalies of ocular dimensions with increased corneal diameters and axial lengths, and in several cases glaucomatous distension of the optic discs could also be found. A possible explanation for these buphthalmic changes and their relation to lens luxation taking place very early in life is proposed. The importance of early diagnosis and treatment is discussed.

[Review of 402 goniotrephinations]

In a review of 402 goniotrephinations the preoperative diagnosis was open-angle glucoma in 61%, chronic congestive glaucoma in 21%, acute glaucoma in 11%, secondary glaucoma in 5%, and juvenile glaucoma in 2%. In 77% of the eyes followed for periods of up to seven years IOP returned to normal. Supplementary local therapy or digital eyeball massage raised the percentage of eyes with normal pressure values to 92,8%. Visual acuity was maintained or improved in 76%. There was no case of visual field defect during the early postoperative period, and no correlation was found between the regulation of IOP and the condition of the filtering bleb. In 10,4% complications occurred during the early postoperative period and in 1% late complications were seen. In 45% of the secondary glaucoma cases and in three out of seven cases of buphthalmus IOP was normalized.

Characteristics of Children With Primary Congenital Glaucoma Receiving Trabeculotomy and Goniotomy

PURPOSE

To describe the groups of patients who received trabeculotomy or goniotomy for the treatment of primary congenital glaucoma (PCG) regarding age at treatment, intraocular pressure (IOP) outcome, and medication burden.

METHODS

A retrospective chart review of patients with PCG seen at Rutgers New Jersey Medical School, Newark, New Jersey, from 1998 to 2012 was conducted. Inclusion criteria were patients who received trabeculotomy or goniotomy with at least 9 months of follow-up. Presenting examination, surgical intervention, IOP, and number of medications at 1 and 2 years postoperatively were recorded. Absolute and qualified success, defined as IOP greater than 5 and less than 21 mm Hg without and with medications, respectively, was determined.

RESULTS

Fifty eyes of 29 patients were diagnosed as having PCG. Of those, 25 eyes received trabeculotomy or goniotomy, with 19 fulfilling inclusion criteria. Average age at the time of trabeculotomy was 8 months versus 21 months for patients undergoing goniotomy. Mean IOP was significantly reduced (P < .001) for both trabeculotomy and goniotomy by 29.5% at 1 year and 33.3% at 2 years. There was no significant difference in IOP control between trabeculotomy and goniotomy groups. Patients in the goniotomy group were treated with significantly more medications before and after surgery compared to patients receiving trabeculotomy (P < .01), resulting in a greater rate of absolute success in trabeculotomy at 1 and 2 years.

CONCLUSIONS

Patients with PCG who underwent trabeculotomy had higher IOP and were treated at an earlier age than those who had goniotomy. Both effectively lowered IOP up to 2 years with greater medication burden in patients receiving goniotomy.

Surgical Outcomes of Visco-Circumferential-Suture-Trabeculotomy Versus Rigid Probe Trabeculotomy in Primary Congenital Glaucoma: A 3-Year Randomized Controlled Study

PURPOSE

The aim was to compare the long-term surgical outcomes of visco-circumferential-suture-trabeculotomy (VCST) and rigid probe viscotrabeculotomy (VT) in patients with primary congenital glaucoma (PCG).

PATIENTS AND METHODS

The study was conducted on 84 (47 right) eyes of 49 (32 males) children PCG to the pediatric ophthalmology unit of Mansoura Ophthalmic Center of Mansoura University, Egypt between 2015 and 2018. An initial office examination was followed by an examination under general anesthesia to establish the diagnosis of PCG. The children were then scheduled for surgery and the eyes randomly assigned to VCST or VT. Follow-up visits were scheduled at the first day, first week, first, and third months and then every 3 months for 1 year.

RESULTS

The mean±SD age of the study children at presentation was 4.8±2.1 and 4.9±1.7 months in the VCST and the VT groups, respectively (P=0.827). The mean±SD preoperative intraocular pressure (IOP) was 29.13±3.3 and 29.89±3.2 mm Hg in the VCST and VT groups, respectively (P=0.292) and 11.9±1.3 and 13.8±1.2 mm Hg at the end of 36 moths of follow-up (P<0.001). The IOP at all follow-up time points (except at the third month, P=0.924) was statistically significantly less in the VCST group than in the VT group (at week 1, month 1, 6, 9, 12, 18, 24, 30, and 36 the P<0.001). The cumulative probability of success was 100%, 95%, 90%, and 90%, respectively in VSCT and 100%, 72.7%, 97.7%, 90.9%, and 84% in VT at 12, 24, 30, and 36 months.

CONCLUSIONS

Both VCST and VT were effective and safe for lowering the IOP in PCG with VCST providing a marginal advantage over VT.

Rhegmatogenous retinal detachment associated with primary congenital glaucoma

BACKGROUND

The development of rhegmatogenous retinal detachments (RRDs) in eyes with a history of congenital glaucoma (CG) is very rare. We present the characteristics and surgical outcomes of three cases with a RRD who had CG and had undergone surgery many years earlier.

CASES

Three men, ages 14, 43, and 48 years of age, each with a history of surgery for primary CG, presented with a RRD. All of the eyes were highly myopic. The retinal tears were located at the equator in all cases. The degree of RRD were superior half, total, and total (proliferative vitreoretinopathy).

OBSERVATIONS

Vitrectomy was performed and the retinas were reattached in all cases. However, the visual acuity in all cases remained poor.

CONCLUSIONS

Our findings indicate that a posterior vitreous detachment due to advanced vitreous liquefaction in the highly myopic eyes may have been the cause of the RRD. We recommend periodic fundus examinations in patients with CG, because while the RRD in patients with CG can be reattached the functional recovery may not be good.

Buphthalmos in the setting of persistent hyperplastic primary vitreous cataract

PURPOSE

To report a case of unilateral persistent hyperplastic primary vitreous cataract presenting with ipsilateral buphthalmos.

DESIGN

Retrospective case report.

METHODS

The patient chart was reviewed, and a relevant literature search was performed.

RESULTS

A four-month-old child presented with persistent hyperplastic primary vitreous cataract in the right eye and ipsilateral buphthalmos with no discernable angle abnormalities. He underwent lensectomy, anterior vitrectomy, and limited transscleral diode cyclodestruction in the right eye.

CONCLUSIONS

This appears to be the first report of buphthalmos presenting with unilateral persistent hyperplastic primary vitreous. Despite two comorbidities, the patient has thus far responded well to initial treatment and visual rehabilitation.

Buphtalmie secondaire à un kyste congénital de l’épithélium pigmentaire de l’iris

We report the case of a 2-day-old child with buphthalmia caused by a congenital pigmented epithelial iris cyst. The use of ultrasound biomicroscopy (UBM) and high-resolution echography (20MHz) specified the diagnosis before general anesthesia for complete examination and treatment. Surgery can control intraocular pressure and the opening of the visual axis; there is, however, relative amblyopia. This case confirms the advantage of UBM in examining tumors of the anterior segment. The early diagnosis, facilitated by use of the UBM, provided quick and well-adapted treatment.