A case of developmental glaucoma suspected from megalophthalmos represented by obstetric ultrasonography

Abstract

A male neonate was delivered normally in the 38th week of gestation. The patient weighed 2730 g and was 48.8 cm long at birth. The Apgar score was 10. He was referred to the Department of Ophthalmology, Mie University Hospital by a local ophthalmologist for megalophthalmos and elevated IOP in both eyes (OU) on the 10th day after birth. He had no significant family history. Family history revealed that the mother of the patient was a 20-year-old primipara receiving systemic steroid therapy for chronic nephritis. Obstetric ultrasonography at 30 gestational weeks had revealed the neonate to have megalophthalmos OU. At 35 gestational weeks, the ocular axial length measurements OU were 23–25 mm (Fig. 1) and about 24 mm based on B-scan ultrasonography and magnetic resonance imaging (MRI) images (Fig. 2), respectively. A disproportion in volume between eye and orbit was noticed, but no other abnormal findings were detected on the images. An ophthalmic examination revealed diffuse corneal opacification and corneal edema OU; consequently, the fundus could not be observed. The horizontal corneal diameter was 14 mm in the right eye (OD) and 13 mm in the left eye (OS). The intraocular pressure on a Perkins hand-held applanation tonometer was 34 mmHg OD and 42 mmHg OS. The diagnosis was bilateral early-onset developmental glaucoma. On his 17th day of life, the patient underwent a trabeculotomy of about 120 dextent OU with a scleral flap at