Long Term Evaluation of Primary Congenital Glaucoma Management In Sohag University Hospital
Conditions: Primary Congenital Glaucoma
Sponsor: Sohag University

    Sohag University   
             Faculty of Medicine 
Department of Ophthalmology    
 
Long term evaluation of Primary Congenital 
Glaucoma Management in Sohag University 
Hospital 
 Presented by 
 
Dr.Ghada Fathy Mohamed Hussein 
M.B.B.Ch 
 
 In partial fulfillment of master degree in ophthalmology 
 
 Under supervision of 
 
Prof.Khulood Muhammed Mahmood Sayed 
Professor of Ophthalmology    
Assist.Prof.Marwa Mahmoud Abdellah 
Assistant Professor of Ophthalmology 
 
Sohag University 
2021 
 
 
 
 
 

Introduction:  
Primary congenital glaucoma is the most frequent childhood glaucoma and an Important 
cause of blindness(1) ,PCG due to genetically determined abnormalities in trabecular 
meshwork and anterior chamber angle in absence of other eye and systemic developmental 
problems,resulting in elevated intraocular pressure.(2) 
Elevated IOP is associated with classic triad of symptoms(photophobia,epiphora and 
blpharospasm) wich occur due to rapid expansion of the eye causing buphthalmos(Greek”ox 
eye”),corneal enlargement,horizontal or oblique breaks in Descemet membrane(Haabstriae) 
and subsequent corneal edema and opacification.IfHaabstriae and buphthalmos are seen 
without elevated IOP,optic nerve cupping or corneal edema,then the patient has spontaneous 
arrested PCG.(2) PCG is bilateral in 65-80%.(3) 
Genetic consanguinity is arisk factor.Parents of PCG patient should be aware that the chance 
of second child with PCG is small but real.(4) 
The management of PCG is directed toward lowering and controlling the IOP and treating 
secondary complications such as refractive changes and amblyopia.If IOP controlled,vision in 
the better eye ultimately can be 20/60 or better.(5)  
The treatment is surgical mainly and the medical therapy used as an adjunction to surgery,the 
primary goal of all surgical procedures is to eliminate the resistance to aqueous out flow 
caused by the anatomical anomaly in the anterior chamber angle.(6) 
 There are four major surgical options, angle surgeries aim to open up the drinage system of 
the eye either from inside (goniotomy),or the out side(trabeculotomy or viscocanalostomy) 
.Filtrating surgeries involve making a new drinage pathway for the eye(trabeculectomy ,deep 
sclerectomy and using glaucoma drinage devices).Cyclodestructive procedure and combined 
surgeries.(2) 
 The mainstay is angle surgery if not successful,trabeculectomy enhanced with mitomycin C 
or implant surgery. 
Mitomycin C is an antimetabolite used during the initial stages of trabeculectomy to prevent 
excessive postoperative scarring and this reduce risk of failure.(7)  
Ologen is a flexible bio-degradable collagen matrix of animal origin,efficacy seem to be at 
least similar to that of MMC with advantage of being removed in case of hypotonia and the 
filtration blebs are flat and vascularized without increasing risk of hypotonia,infection or bleb 
leak. (8) 
 The prognosis for children with PCG is quite variable,with some achieving good 
vision,while other go blind.(4)vision loss secondary to corneal scarring or optic nerve damage 
,and often amblyopia in asymmetrical or unilateral cases.(9) 
Aim of the work:  
The purpose of the present study is evaluationof management andsuccess rate ofthe cases of 
primary congenital glaucoma in pediatric out patient clinics at Sohag university hospital.  

 
 
Patient and methods:  
This is a retrospective,case series study of cases of primary congenital glaucoma presented to 
pediatric out patientclinics at Sohag university hospital for evaluation and management. 
 Inclusion criteria: 
-children with operated PCG  >3 month of age 
Exclusion criteria  
-other types of operated pediatric glaucoma 
Reviewing each patient data sheet that includes : 
-detailed history : age , sex , onset and family history.  
-examination under general anaesthesia including :  
a-Anterior segment examination:transverse corneal diameter, corneal clarity,corneal edema and 
presence of  Haab striae.  
b-IOP measurement:the main diagnostic test,done under anaesthesia using Perkins tonometer . 
c-Gonioscopy: detect angle abnormalities to exclude secondary glaucoma. 
d-Cycloplegic refraction to look for myopia and astigmatism.  
e-Axial lenghth by A-scan ultrasonography. 
f-optic  nerve evaluation by direct or indirect ophthalmoscopy attention to cup to disc ratio. 
g-B-scan if cornea dosenot allow fundus examination. 
h-Informed consent will  be taken from parents of these  children . 
i –Approval  from the  Health Research Ethics Gommittee in sohag faculty of  medicine . 
j –IOP followup and vision. 
Follow-up regimen : 
At different follow up period was recorded . 
List of abbreviations: 
PCG:primary congenital glaucoma. 
 IOP:intraocular pressure. 
MMC :mitomycin C. 

 
 
References: 
1- Journal of pediatric ophthalmology and strabismus 41(5),271-288,2004. 
2- Weinreb,R.N.Grajewski A.L.,Papadopoulos M.,Grigg J.,Freedmans.F childhood 
glaucoma:the 9th consensus report of the World Glaucoms Association.Netherland:Kugler 
publication,2013. 
3- Duke-Elder S congenital Deformities.St Louis:CV mosby;1969.548-65p. 
4- Deluise VP,Anderson DR.Primary infantile glaucoma(congenital glaucoma).Surv 
Ophthalmol.1983;28:1-18.  
5- BiglabAW,Hiles DA-the visual results following infantile glaucoma 
surgery.JpediatrOphthalmol Strabismus.1979;16(6)377-81. 
6- J Francois Ophthalmological 181(2),61-73,1980.  
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Database of systematic Review 2005,Issue 4. 
8- Cilinos,CasuccioA,Dipacef,Cagini,Ferraroll,Cillino G.Biodegradable collagen matrix 
implant versus Mitomycin C in trabeculectomy:five year follow up.BMC 
Ophthalmology(2016)16-24. 
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glaucoma including next generation sequencing-based approach:clinical utility gene 
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