A Case of Primary Congenital Glaucoma

An 11-year-old girl and a case of primary congenital glaucoma (PCG) with negative family history of glaucoma, was referred to our glaucoma service for uncontrolled intraocular pressure (IOP). Maximum tolerable medications and multiple glaucoma operations had failed to control her IOP. Review of the patient’s chart revealed an IOP of 30 mmHg and horizontal corneal diameter of 11.5 mm in both eyes when she had been 3 days old, at the time which she underwent superior and inferior trabeculotomy in both eyes at a single session. One year later, she had IOP of 30 mmHg in both eyes without optic nerve head cupping; however, corneal diameters had increased to 14 and 13.5 mm in the right and left eyes, respectively. The patient continuously received two topical glaucoma medications for 8 years thereafter with IOPs remaining around 28 mmHg. At 9 years of age, she underwent mitomycin C (MMC) augmented trabeculectomy in both eyes. Upon referral, the patient was on four topical agents including timolol, brimonidine, latanoprost and dorzolamide eye drops. Ten days after discontinuing all of these medications, IOP was increased from 35 to 56 mmHg and from 30 to 54 mmHg in the right and left eyes, respectively. Table 1 summarizes the results of her most recent ocular examination. The optic nerve heads of both eyes are displayed in figure 1, and figure 2 demonstrates the superior bulbar conjunctiva of both eyes. • What are the important points about her corneal thickness (CCT) and IOP? • What would your target IOP be for this patient? • What is the preferred management for this patient?