A case of spontaneously resolved primary congenital glaucoma.

Abstract

Sir, We read with interest the article by Sanghi et al. “A case of spontaneously resolved primary congenital glaucoma” and congratulate them for presenting this rare case.[1] We feel the authors should provide additional details of clinical examination findings to support the diagnosis of regressed primary congenital glaucoma (PCG). The authors state that the corneal diameter was 13.5 mm in the right eye with Haab's striae in the nasal half, with normal posterior segment and gonioscopy findings, and a normal fundus examination. In infants and young children, elevated intraocular pressure (IOP) may cause enlargement of the globe (buphthalmos), limbal tissue (limbal ectasia with the deep anterior chamber) and cornea, leading to circumferential, and horizontal ruptures of the Descemet's membrane (Haab's striae).[2] In PCG, enlargement is mainly at the corneoscleral junction. Single or multiple breaks in Descemet's membrane (Haab's striae) may result in irregular astigmatism.[3] The anterior segment photograph of the right eye reveals an enlarged cornea with Haab's striae but does not show limbal ectasia or a deep anterior chamber. The sclera also expands gradually when exposed to an elevated IOP, with increasing axial length and resultant myopia and astigmatism.[4] Enlargement of the globe with elevated IOP during the first 3 years of life creates a myopic shift and may lead to amblyopia and significant astigmatism.[5] Myopic astigmatism and anisometropia occur in children with PCG (the latter is almost always present in unilateral cases).[4] The patient, in this case, the study had simple hypermetropic astigmatism of +1.00 D only. The axial length of both eyes needs to be mentioned. Measurement of the axial length has been recommended by some investigators for routine use in diagnosis and follow-up of congenital glaucoma, contending that the axial length is a sensitive and reversible measure of the disease.[3] The disc photographs and corresponding optical coherence tomography–retinal nerve fiber layer (RNFL) scans shown in Fig. 6. Furthermore, do not show any significant thinning of the RNFL. The visual field of the right eye [Fig. 5] does not reveal any scotoma and appears to be normal. The authors state that gonioscopic examination revealed prominent iris processes in the right eye. There is no evidence to suggest any prior angle anomaly in the right eye. PCG patients have angle anomalies, that is, a more anterior iris insertion, with the altered translucency of the angle face rendering the ciliary body band, trabecular meshwork, and scleral spur indistinct.[5] Nagao et al., in their study reporting spontaneous resolution of PCG, stated that all the 14 eyes studied showed a deep anterior chamber, with a clear lens, but abnormal angles with a typical appearance of PCG.[1] In conclusion, we wish to differ with the diagnosis of unilateral spontaneously-regressed PCG in the patient reported by Sanghi et al. since the patient has no prior records or photographs providing evidence of PCG. Moreover, we are of the opinion that the reported observation by the patient of whitish discoloration of the right eye during childhood, which spontaneously cleared in due course of time, is not convincing enough to accept that this is a case of spontaneously-regressed PCG. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.