Congenital glaucoma I. Etiology: a disease caused by abnormal development of the anterior atrial horn during embryonic period, which hinders atrial aqueous drainage, 1/3 appear in the fetal period, with typical signs after birth, 2/3 appear after birth, with an incidence of 1:5000-10000; 60%-70% are male; 64-85% are binocular, with two common categories: one with no other diseases, and one with other The pathogenesis is as follows: 1. The atrial horn tissue is covered by a layer of mesangial remnants, so that atrial water cannot enter the trabecular meshwork, and Schlemm’s canal is mostly normal, which accounts for the majority of cases.
2. The anterior atrial horn structure is not developed or is underdeveloped, the Schlemm canal is occluded or missing from the trabecular meshwork, and the front end of the ciliary muscle exceeds the scleral eminence.
Classification 1. Infantile glaucoma: It is the most common type of congenital glaucoma and may be primary or secondary to other ocular or systemic congenital abnormalities.
2, juvenile glaucoma: the onset is insidious and progresses slowly, so it is often neglected, mostly seen in adolescents under 30 years old. The atrial angle is characterized by: ① the iris is attached to the scleral prominence or posterior trabeculae; ② the atrial angle crypt is buried; ③ the trabecular network is widened and the transparency is reduced; ④ the anterior boundary line is thickened and protrudes into the anterior chamber obviously, the trabecular network is covered by residual mesangial tissue, and the iris protrudes more than normal.
Clinical manifestations 1. The child often cries and has heavy photophobia, lacrimation and eyelid spasm.
2. The cornea is foggy and cloudy, with an enlarged diameter of more than 11 mm, and in severe cases there are striae of cloudiness and cracks in the posterior elastic layer.
3. The anterior chamber is very deep.
4.The pupil is mildly dilated.
5. Fundus: In advanced cases, the optic disc is pale and has a ring-like depression.
6.IOP is very high.
7. Enlarged eyeball.
The shorter the course of the disease, the better the result. About 80-85% of those operated on within one year of age can receive good results. These children should be examined in detail before surgery, because they often have other developmental abnormalities of the body and eyes.
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