Abstract
ABSTRACTDespite being documented in medical history from over 2400 years ago, primary congenital glaucoma (PCG), being a disease with low incidence rate, remains a challenge to ophthalmologists.The article provides a broad overview on the pathophysiology and diagnostic approach to PCG with major emphasis on the treatment options of PCG. While reviewing on the well-established treatment options, namely goniotomy, trabeculo-tomy and combined trabeculotomy-trabeculectomy, emphasis has also been made to recent updates on secondary treatments: trabeculectomy, antimetabolites, glaucoma-drainage devices and cyclodestructive procedures.It is, however, important to note that the rarity of PCG places limitations on study design, most studies are, thus, retrospective, nonrandomized and have different definitions of surgical success. Ophthalmologists need to interpret the results with critical thinking and formulate individual treatment plans for each patient.How to cite this article: Yu Chan JY, Choy BNK, Alex LK Ng, Shum JWH. Review on the Management of Primary Congenital Glaucoma. J Curr Glaucoma Pract 2015;9(3):92-99.
Highlights
Primary congenital glaucoma (PCG) is rare disease which constitutes a diagnostic and therapeutic challenge to ophthalmologists
We provide an overview and update on the presentation and treatment options of PCG
A more recent study, on the other hand, demonstrated no significant difference in mean intraocular pressure (IOP) lowering between groups with trabeculotomy and combined trabeculotomy-trabeculectomy, but statistically significantly higher success rate is achieved in combined surgery compared with trabeculectomy.[52]
Summary
Primary congenital glaucoma (PCG) is rare disease which constitutes a diagnostic and therapeutic challenge to ophthalmologists. Filous et al utilized one of three different probes in a retrospective study, stratifying patients according to their corneal diameters This modified procedure was able to cause a mean decrease of 47% in IOP with surgical success achieved in 87% of the eyes.[49] prospective study comparing traditional trabeculotomy with this modified trabeculotomy is not available. The patients receiving AGV are two times more likely to be on antiglaucoma medication for IOP control, and the AGV patients have a poorer visual outcome, with a visual acuity drop of three lines (28% vs 12%).[72] Take note that the above two studies may have selection bias as secondary glaucoma were included, which are known for having a lower trabeculectomy success rate. GDD is associated with more complications that requires reoperation than trabeculectomy (46% vs 13%), in particular displacement of tube leading to tube-endothelial touch and tube retraction.[68,71]
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