gms | German Medical Science

The treatment of congenital glaucoma is characterized by several special requirements. The short-term and long-term follow-up are as important as diagnosis and surgery to obtain a good final result. The following 4 points are of importance during the postoperative management.

1. Control of intraocular pressure (IOP).

2. Control of growth of the eyeball.

3. Refraction.

4. Treatment and/or prophylaxis of amblyopia

A short general anesthesia with ketamin is usually required for IOP measurement in infants. During the first postoperative days, macroscopic inspection of the anterior segment may be sufficient to rule out hyphema or flat anterior chamber and IOP may be estimated by digital palpation. A precise measurement of IOP and a microscopic examination is usually performed in general anesthesia after 1 week, and conjunctival sutures should be removed on that occasion to avoid stimulation of scarring. If bilateral glaucoma is present, the second eye may be operated during the same anesthesia. With uncomplicated course, the next IOP measurements should be after 1 month and after 3 months.

The growth of the eyeball is best followed with corneal diameter and ultrasonographic axial length measurements before surgery and 3 months thereafter, and at later follow-up examinations.

Refraction must be determined intraoperatively and on each follow up examination. Full correction must be prescribed as early as possible even when gross anisometropia is present.

Amblyopia treatment should start after the first follow-up examination if needed, particularly if unilateral congenital glaucoma is present. Myopia is the most frequent refractive error (70%). Strabismus develops in about one quarter of the patients. In our study, normal binocular functions were found in nearly half of the cases.

Correction of refractive errors and treatment of amblyopia as well as control of IOP and growth of the eyeball are the most important factors for good visual rehabilitation in congenital glaucoma.