eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma, Primary Congenital: Follow-up

Author: Gerhard W Cibis, MD, Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas, Kansas City
Coauthor(s): Robert C Urban, Jr, MD, Medical Director, Glaucoma Associates, Oaklake Medical Center; Andrew A Dahl, MD, Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine
Contributor Information and Disclosures

Updated: Feb 13, 2009

Follow-up

Further Outpatient Care

The follow-up care of patients with primary congenital glaucoma has several important facets. In the early postoperative period, close observation is required regarding success of the procedure. This may require multiple examinations under anesthesia.

Complications

  • Serious complications of surgical intervention include hyphema, infection, lens damage, and uveitis.
  • The most serious complications in children often are caused by general anesthesia. Because of anesthetic risks, bilateral procedures are indicated in some children.

Prognosis

  • Corneal edema may persist for weeks after successful reduction of the intraocular pressure. Changes in the optic nerve head provide the most important indicator of the course of the disease. Cupping can reverse in successfully treated cases.
  • The intraocular pressure also is a significant factor in postoperative visual capacity, with substantially better vision among those patients whose pressures remain no higher than 19.
    • Even when the intraocular pressure is well controlled, approximately 50% of children do not achieve vision better than 20/50.
    • Reduced visual acuity may result from persistent corneal edema, nystagmus, amblyopia, or large refractive errors.

Patient Education

  • The patient and family must understand that intraocular pressure elevation can recur at any age in individuals with primary congenital glaucoma, and these patients must receive follow-up care throughout their lives.
  • For excellent patient education resources, visit eMedicine's Glaucoma Center. Also, see eMedicine's patient education articles Primary Congenital Glaucoma and Glaucoma Overview.

Miscellaneous

Medicolegal Pitfalls

Since most of these patients are preverbal children, it is extremely important to thoroughly investigate any suspicious clinical findings.

 


More on Glaucoma, Primary Congenital

Overview: Glaucoma, Primary Congenital
Differential Diagnoses & Workup: Glaucoma, Primary Congenital
Treatment & Medication: Glaucoma, Primary Congenital
Follow-up: Glaucoma, Primary Congenital
References
[ CLOSE WINDOW ]

References

  1. Gupta V, Jha R, Srinivasan G, Dada T, Sihota R. Ultrasound biomicroscopic characteristics of the anterior segment in primary congenital glaucoma. J AAPOS. Dec 2007;11(6):546-50. [Medline].

  2. Tamcelik N, Ozkiris A. Long-term results of viscotrabeculotomy in congenital glaucoma: comparison to classical trabeculotomy. Br J Ophthalmol. Jan 2008;92(1):36-9. [Medline].

  3. Bejjani BA. Primary congenital glaucoma. Gene Tests. Available at http://www.genetests.org/. Accessed September 30, 2004.

  4. DP Edward, Fajarananant TS, et al. A comprehensive update on congenital glaucoma. Current Pediatric Reviews. Feb 2008;4(1):19-30.

  5. Sarfarazi Mansoor , inventors; U of Connecticut. Diagnosis of Primary Congenital Glaucoma. US patent 6207394. March 27 2001.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

primary congenital glaucoma, childhood glaucomas, glaucoma in children, increased intraocular pressure, increased IOP, optic nerve damage, vision loss, blindness, aqueous outflow

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Gerhard W Cibis, MD, Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas, Kansas City
Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Robert C Urban, Jr, MD, Medical Director, Glaucoma Associates, Oaklake Medical Center
Robert C Urban, Jr, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Andrew A Dahl, MD, Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine
Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Neil T Choplin, MD, Adjunct Clinical Professor, Department of Surgery, Section of Ophthalmology, Uniformed Services University of Health Sciences
Neil T Choplin, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Association for Research in Vision and Ophthalmology, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Martin B Wax, MD, Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc
Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience
Disclosure: Alcon Labs Salary Employment

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.