الفهرس 
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Abstract
Congenital, infantile or childhood glaucoma all the same terms of a neurodegenerative disease. Primary congenital glaucoma is the most frequent childhood glaucoma and an important cause of blindness, PCG due to genetically determined abnormalities in trabecular meshwork and anterior chamber angle in absence of other eye and systemic developmental problems, resulting in elevated intraocular pressure.
Elevated IOP is associated with classic triad of symptoms (photophobia, epiphora and blepharospasm) which occur due to rapid expansion of the eye causing buphthalmos (Greek “ox eye”), corneal enlargement, horizontal or oblique breaks in Descemet membrane (Haabstriae) and subsequent corneal edema and opacification.
The management of PCG is directed toward lowering and controlling the IOP and treating secondary complications such as refractive changes and amblyopia. If IOP controlled, vision in the better eye ultimately can be 20/60 or better. The treatment is surgical mainly and the medical therapy used as an adjunction to surgery, the primary goal of all surgical procedures is to eliminate the resistance to aqueous out flow caused by the anatomical anomaly in the anterior chamber angle.
There are four major surgical options, angle surgeries aim to open up the drainage system of the eye either from inside (goniotomy),or from outside (trabeculotomy or viscocanalostomy). Filtrating surgeries involve making a new drainage pathway for the eye (trabeculectomy ,deep sclerectomy and using glaucoma drainage devices). Cyclo destructive procedure and combined surgeries.
The prognosis for children with PCG is quite variable, with some achieving good vision, while other go blind. Vision loss secondary to corneal scarring or optic nerve damage and often amblyopia in asymmetrical or unilateral cases.
The purpose of the present study is evaluation the efficacy of management and success rate of the cases of primary congenital glaucoma in ophthalmology department at Sohag university Hospital.
A retrospective, case series study of was conducted on 87 patients of primary congenital glaucoma presented to ophthalmology department at Sohag university hospital for evaluation and management.
The main results of the study revealed that:
This study was conducted on 87 patients (147 eyes), 48(55.2%) were males, while 39 (44.8%) were females, their age ranged from 3 months to 10 years with mean 2.47 ± 2.39 years, the 147 eyes were 74 (50.3%) right , and 73 (49.7%) left, 127 (86.4%) eyes had trabeculectomy, while 20(13.6%) eyes needed retrabeculectomy.
Preoperative IOP was 31.28±5.575 mmHg, then was measured on follow up after 1, 3, and 6 months post operatively and it was 11.35±5.562, 12.693±7.0528, and 12.626±6.1290 respectively, IOP was further followed up for 1, 2, 3, and 5 years post operatively and it was 12.137±6.4846, 13.00±7.231, 15.08±7.933, and 14.65±6.863 respectively.
Preoperative TCD was 12.81±1.68 mm, then was measured on follow up after 1, 3, and 6 months post operatively and it was 13.05±2.02, 12.95±0.80, and 12.90±1.72 respectively, TCD was further followed up for 1, 2, 3, and 5 years post operatively and it was 13.30±1.56, 13.35±0.76, 13.38±1.83, and 13.84±0.73 respectively.
Preoperative CDR was 0.63±0.20, then was measured on follow up after 1, 3, and 6 months post operatively and it was 0.71±1.26, 0.57±0.21, and 0.53± 0.21 respectively, CDR was further followed up for 1, 2, 3, and 5 years post operatively and it was 0.53±0.21, 0.55±0.20, 0.59±0.18, and 0.60±0.18 respectively.
56(38.1%) patients didn’t have any postoperative anti-glaucoma, while 49(33.3%) had one (16 eyes used single postoperative antiglaucoma medication as conservative in case of thin bleb ,not for CTTMO failure), and 42(28.6%) had combined anti-glaucoma postoperative.
from the total number of eyes, 94(64%) had no complications, while the other eyes had complications mainly thin cystic bleb in 16(11%) eyes (three eyes need bleb repair with tenon and conjunctival flap), high IOP in 15(10%) (tweleve eyes need retrab.), hyphaema in 14(10%), following complications happened, choroidal effusion, staphyloma, vitreous haemorrhage, hyperemic optic disc, cataract, blebitis, endophthalmitis, and floating ologen.
Success rate was;94.6% after 6 months of follow up, 93.6% after 1st year of follow up, 84.7% after 2 years of follow up, 83.5 % after 3 years of follow up, 84.6 at the end of 5 years of follow up.
Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.
CONCLUSION
Children with congenital glaucoma (CG) will require surgery in their lifetime which is the mainstay of treatment. Management of CG is however challenging, because of its greater potential for failure and complications as compared with surgery in adults. This is largely due to anatomical factors related to the inherent characteristics of the pediatric eye as ocular enlargement, stretched, thinned sclera, low scleral rigidity and high elasticity make these eyes prone to complications. The available surgical management for CG has remained relatively unchanged for many years. Each surgical option has its disadvantages and advantages with increasing rate of success when chosen appropriately to minimize complications. The most common surgical options may be angle surgery, trabeculectomy and glaucoma drainage devices GDD. Comparing different surgical procedures for PCG, combined procedures were found to be the best for PCG cases, this is because the most common presentation of PCG was hazy cornea which eliminates the possibility of an ab-interno angle procedure; also the combined procedure provides the advantage of the ability to perform trabeculectomy if trabeculotomy failed. In our ophthalmology department at Sohag university Hospital the procedure performed for treating primary congenital glaucoma ; combined trabeculectomy_trabeculotomy with mitomycin and ologen (CTTMO) achieved a good success rates in comparison to other studies.
RECOMMENDATIONS
Further studies on large geographical scale and on larger sample size to emphasize our conclusion.
The prognosis of the PCG is affected by various factors such as time of presentation, severity and the time of surgery. The earlier in life the disease occurs, the worse the prognosis and the more severe the case, the higher is the failure rate.
Trabeculectomy, trabeculotomy, and combined trabeculotomy and trabeculectomy (CTT) are the three major surgical options for congenital glaucoma; goniotomy, deep sclerectomy, and viscotrabeculotomy, as well as glaucoma drainage tube shunts have also been applied in suitable cases.
Further studies should be done for that cases as regard long term follow-up ,visual acuity assessment and a variety of treatments used.