Approach to primary congenital glaucoma: A perspective

IF 1 Q4 OPHTHALMOLOGY Taiwan Journal of Ophthalmology Pub Date : 2023-10-19 DOI:10.4103/tjo.tjo-d-23-00104
Anil Kumar Mandal, Debasis Chakrabarti, Vijaya K. Gothwal
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Abstract

Abstract: Primary congenital glaucoma (PCG) occurs worldwide and has a broad range of ocular manifestations. It poses a therapeutic challenge to the ophthalmologist. A proper diagnostic evaluation under anesthesia is advisable for all children who do not cooperate for an office examination. Medical therapy only serves as a supportive role, and surgical intervention remains the principal therapeutic modality. Angle incision surgery such as goniotomy or trabeculotomy ab externo is the preferred choice of surgery in the Caucasian population. Primary combined trabeculotomy-trabeculectomy with or without antifibrotic therapy is the preferred choice in certain regions such as India and the Middle East where the disease usually presents with severe forms of corneal edema along with megalocornea. In refractory cases, trabeculectomy with antifibrotic therapy or glaucoma drainage devices are available options in the armamentarium. Cycloablative procedures should be reserved for eyes with poor visual potential. Myopia is common among children with PCG, and appropriate optical refractive correction in the form of glasses or contact lenses should be provided. Amblyopia therapy should be instituted to ensure overall visual development in the early developmental years. Low-vision rehabilitation services should be provided to children with vision impairment. Long-term follow-up is mandatory and carers of children with PCG should be counseled and educated about this need. Regardless of the visual outcomes, clinicians should emphasize the need for education of these children during the clinic visit. The overall goal of the management should be to improve the overall quality of life of the children with PCG and their carers.
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原发性先天性青光眼的治疗方法
摘要原发性先天性青光眼(PCG)在世界范围内均有发生,具有广泛的眼部表现。这对眼科医生提出了治疗上的挑战。对于所有不配合办公室检查的儿童,建议在麻醉下进行适当的诊断评估。药物治疗仅起辅助作用,手术干预仍是主要的治疗方式。角切口手术,如阴囊切开术或外小梁切开术是高加索人群的首选手术。原发性小梁切除术联合小梁切除术加或不加抗纤维化治疗是某些地区的首选,如印度和中东,在这些地区,该病通常表现为严重的角膜水肿和大角膜。在难治性病例中,小梁切除术联合抗纤维化治疗或青光眼引流装置是医疗设施中可用的选择。睫状体消融手术应保留给视力差的眼睛。近视在患有PCG的儿童中很常见,应提供适当的光学屈光矫正,如眼镜或隐形眼镜。弱视治疗应在早期发展阶段进行,以确保整体的视觉发展。为视力受损儿童提供低视力康复服务。长期随访是强制性的,患有PCG的儿童的照顾者应该得到有关这一需求的咨询和教育。无论视力结果如何,临床医生都应强调在门诊访问期间对这些儿童进行教育的必要性。管理的总体目标应是提高PCG患儿及其照顾者的整体生活质量。
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来源期刊
CiteScore
1.80
自引率
9.10%
发文量
68
审稿时长
19 weeks
期刊最新文献
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