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Retinal Detachment in Congenital Glaucoma

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Retinal Detachment in Congenital Glaucoma Br J Ophthalmol: first published as 10.1136/bjo.64.6.417 on 1 June 1980. Downloaded from British Journal of Ophthalmology, 1980, 64, 417-421 Retinal detachment in congenital glaucoma R. J. COOLING, N. S. C. RICE, AND D. MCLEOD From Moorfields Eye Hospital, City Road, London ECJ V 2PD SUMMARY This paper reports the occurrence of retinal detachment in 18 patients suffering from congenital glaucoma. Difficulty in establishing control of the glaucoma and the presence of high myopia were common findings. The poor results of detachment surgery were related to opacities in the media preventing evaluation of the retinal details and the development of massive preretinal retraction. Detachment of the retina complicating congenital cases which do not have any other developmental glaucoma was first described by Axenfeld,l who anomaly, either ocular or systemic, and show considered that the detachment was often the typical gonioscopic appearances.6 Complicated con- determining factor in the production of blindness in genital glaucoma refers to cases in which glaucoma this condition. Knapp2 also reported this develop- is related to other developmental defects of the eye ment in an 11-year-old child with advanced anterior with or without extraocular abnormalities. segment changes of congenital glaucoma; he con- A detailed profile of each patient was constructed sidered that degenerative changes within the vitreous from the clinical records, and particular attention were implicit in the development of retinal detach- was directed to the following factors: age of onset ment. of glaucoma; family history of glaucoma or retinal Cases of congenital glaucoma complicated by detachment; glaucoma surgery undertaken and the retinal detachment have also been mentioned within control of intraocular pressure achieved; the maxi- surveys of juvenile detachment.3-5 In these series a mum corneal diameter recorded and the refractive total of 11 cases of congenital glaucoma were en- error; the age at which the patient developed retinal countered among 672 cases of retinal detachment detachment, the type and extent of the detachment, http://bjo.bmj.com/ within the first 2 decades of life. and the nature of retinal breaks and other retinal This report concerns 18 patients with retinal abnormalities encountered; the retinal status of the detachment associated with congenital glaucoma. fellow eye; retinal surgery undertaken and the The clinical characteristics of these detachments results achieved. and the salient features of the associated glaucoma are described together with the results of retinal Results detachment surgery. The incidence of retinal detach- ment in a closely studied series of patients with Retinal detachment occurred in 21 eyes of 18 patients on September 28, 2021 by guest. Protected copyright. simple congenital glaucoma is also reported. with congenital glaucoma of varying aetiology. There were 13 males and 5 females. The details of Patients and methods the glaucoma and the principal features of the retinal detachments are presented in Table 1. We reviewed the clinical records of 189 patients Congenital glaucoma was classified as simple in with congenital glaucoma involving 290 eyes who 16 and complicated in 2 of our patients. The age of were treated at Moorfields Eye Hospital between onset of glaucoma ranged from 3 weeks to 12 1960 and 1979. Thirteen eyes of 11 patients suffered months and was bilateral in 16 and unilateral in a retinal detachment. In addition 7 patients presented 2 cases. Glaucoma surgery was undertaken in 18 during this same period with retinal detachment in eyes of 16 patients, including filtering procedures in association with congenital glaucoma which had 10 eyes. Surgery was not performed on 1 eye with been managed elsewhere. simple glaucoma which had undergone spontaneous The glaucoma was classified as either simple or arrest and both eyes of a patient with bilateral complicated. Simple congenital glaucoma refers to Sturge-Weber syndrome. Satisfactory control of the glaucoma was achieved in 10 eyes of 11 patients. Correspondence to Mr R. J. Cooling, FRCS. The interval between the onset of glaucoma and 417 Br J Ophthalmol: first published as 10.1136/bjo.64.6.417 on 1 June 1980. Downloaded from 418 R. J. Cooling, N. S. C. Rice, and D. McLeod -.: C 00b 0 a .d ._Cu 0 iXDv Z v | U Z U 3~~~ 0 > .0 .0 Cd E u < II < I -0 la L; W " 4 c D) C)CL 0. 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C 0- .t 0t 0 C Q ' -- i =E M E E~ | I U L <~~~L <iLL< 0 ~~~~~~~~~~~~~~~~~~~0 A 0 E . E cEm E y E r w C)C n C CO 00(° .e H° uC .C F F0 F C F .bo .e L H0 0C 0)~~~~~~~~~V ._0 C), 00 0 )0 -CC 0 ~~~~~~~Cu~~~~~~~~~~~ Cu 0 0._ V: ~~~00 ° C) C)@°E < < Y Y - .j Cut.j§.j . .j _uCu, S E 0.q http://bjo.bmj.com/ I0~c~ A I en I 00 0 0 C C) 0 Cu C 0 0D i0 -t ell £ z 0 L. - 0 0 0D0 " - en o0 IC 'o- u zo -~c ~~T zo zo zo U U \0 IC C C 0._ 0 0 0 c a 0 .11c 0 0 0... 0 .00. 8) .0x 08 ,o g Ig I8 8 8 H 00 0 r I8 r 8I 0 0 0 - 00 00 00X 0 -_ A 4 z -1 _ _+ 7 1~ _ -+ 11 on September 28, 2021 by guest. Protected copyright. -1- ~~~~~+ 0.0 0 .0 0 000 0 0 0 0 0 0 Cu 0 0 0 0 0 0 0 0, 0 0 0 0 00. x VZuXX X X V X X 0 ~~~~~~~x x .0 0.200 0 - 0.0. ca0a -a 0.0. 0. 0.. 000 3vE4rff=E = '=' °- oE0CE E E Z Z Cu u0 Cu Clf _ ~~ ~ ~ ~ 06~~~~0 _ _ _ _ _ Br J Ophthalmol: first published as 10.1136/bjo.64.6.417 on 1 June 1980. Downloaded from 420 R. J. Cooling, N. S. C. Rice, and D. McLeod the development of retinal detachment ranged from 7 months to 33 years. The presenting features of retinal detachment included ocular hypotension with or without lens subluxation in 9 eyes, subjective visual loss in 8 eyes, vitreous haemorrhage in 3 Fig. I Central eyes, and the observation of retinal detachment horizontal B-scan shortly after filtering surgery in 1 eye. A wide range section of right eye of refractive errors was encountered. Of a total showing retinal of 18 eyes in which the error could be measured detachment and 15 eyes were found to have myopia in excess of ..*..-choroidal haemangioma 2 50 dioptres and in 8 eyes to be 10 or more dioptres (arrow). as expressed in spherical equivalents. Retinal detachment was unilateral in 15 and bilateral in 3 cases. With the exception of serous detachments in both eyes of the patient with bilateral Sturge-Weber syndrome the detachment was con- sidered to be rhegmatogenous in all cases. However, retinal breaks were identified in only 9 eyes and wherever possible. In one eye a flat u-tear in tem- included u-tears in 4 eyes, round holes in the tem- poral retina was identified for which prophylactic poral periphery with multiple incomplete dialyses cryotherapy was undertaken. In a further case the in I eye, giant pre-equatorial tears in 2 eyes, and fellow eye of a patient with a giant retinal dialysis giant dialyses in 2 eyes. showed marked cystoid degeneration of the ora Retinal detachment surgery was undertaken in a serrata in all quadrants, which was treated by 360° total of 13 eyes of 12 patients. The limited potential cryotherapy. for useful visual recovery together with the presence Twelve eyes of 10 patients in this study belonged of significant corneal and lens opacities were the to a closely studied series of 158 cases of simple major factors precluding any attempt at surgical congenital glaucoma involving 246 eyes followed by management in the remaining 8 eyes.
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