Primary Congenital Glaucoma

We present two cases of patients with primary congenital glaucoma (PCG) and buphthalmos who underwent cataract surgery and Glaucoma Drainage Implant (GDI). The first case is a young adult, VA 20/60 in the right eye and hand movements (struggle) in the left eye. Intraocular pressure measured with Goldmann applanation tonometry was 30mmHg and 20mmHg in the right and left eyes respectively. Slit lamp examination showed Haab striae and corneal haze in the right eye, and the left eye showed GDI located superotemporal (ST)and inferotemporal (IT). Tube erosion was noted in the ST region with an area of limbal staphyloma. Band Keratopathy, 360 degrees with a central calcific plaque blocked the anterior chamber and view of the posterior pole. Fundus photo of the right eye showed a pale, cupped nerve (CDR0.9). The axial length (AL) was 30.53mm, anterior chamber depth (ACD) 5.19mm in the right eye. Prior to surgery the patient was on Timolol, Latanoprost, Brimonidine and Acetazolamide. Post operatively VA was 20/60, IOP was maintained at 15mmHg on topical treatment, Timolol and Brimonidine only. 

The second case is a young adult with monocular vision, VA 20/200, IOP 46mmHg in the right eye and prosthesis in the left eye. This patient underwent angle surgery twice in the right eye. The left eye had a history of cataract and retinal detachment which required eventual enucleation due to severe painful blind eye. Slit lamp examination showed Haab striae, multiple iris tears and nuclear sclerotic cataract. Posterior pole showed optic nerve cupping. The patient has been on maximal topical therapy (MTT) Timolol, Brimonidine, Latanoprost, Dorzolamide, Rhopressa and Acetazolamide as a temporizing measure prior to surgery. A-Scan biometry showed AL 25.92 and ACD 4.37mm. Post operatively VA was 20/50 and IOP was 17mmHg maintained on Timolol only.

Presentation Date: 07/13/2023

Issue Date: 07/28/2023