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Congenital Glaucoma
Managing glaucoma in
the infant
Ahmad Khalil, MD, PhD |
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Dr Khalil has successfully operated
on more than 800 surgeries for children with congenital glaucoma>
This is one of the highest figures internationally for this rare
disease. This is also due to many referrals from various primary
and secondary care doctors and centers. With the high success rates
of his technique of modified trabeculotomy, and his extensive work
on the subject, many institutions and congresses have shown their
interest, and Dr Khalil was invited in many occasions to lecture and
give instruction courses on this topic in international meetings. He
has also written many reference book chapters on the topic. Because
of the importance of this subject and its relevance to the benifit
of those young infants afflicted with this rare disease, This
separate page has been written to suit the non-specialized reader
and families of infants with congenital glaucoma |
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Dr Khalil honored by giving a lecture on congenital glaucoma
in the World Glaucoma Day organized by Pecs University (Professor Szolt
Biro, and Dr Zcilla Ajtomy) in Hungary
Congenital glaucoma is a rare disease
caused by rise of the pressure inside the eye of the newly born or infant. Due
to the elastic nature of the infant eye, it yields to pressure rise and swells
gradually resulting in enlargement of the eye, and in more advanced cases, fluid
is pushed through the cornea (the transparent part in front of the coloured
iris), leading to its cloudiness and grayish discoloration (Buphthalmos, fig). Because of
this abnormal fluid inside the cornea, the infant becomes very intolerant to to
bright light, and his eyes tearing.
It is, therefore extremely important to
seek expert medical advice if the parents see/suspect any of the following signs
in their baby.
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excessive lacrimation/ tearing of the
eyes especially in bright light
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abnormal enlargement of one or both
eyes
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a difference in eye size between right
and left
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abnormal grayish or bluish
discoloration of the eye
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Dr Khalil measures the eye pressure of an infant
in office without the need for general anesthesia or sedation.
This is achieved by giving the child confidence and trust in the
firsttimes of examination, and by the mother training her child
before each examination, and
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Examination under anesthesia
It is customary to examine children with congenital glaucoma in the
first few years under general anesthesia or sedation. As the child
grows, and with proper training, this can be changed to an office
setting
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Treatment of
Congenital Glaucoma
Due to the young age of children having glaucoma, medical treatment
can not be resorted to, except for temporarily, ie: prior to
surgery. Medical treatment can not be the line of treatment in those
infants for several reasons: 1-it is not very effective. 2-there is
no long term studies on its use in children 3-it is practically
difficult to force continuous medical treatment on those children
with long life expectency.
Surgery for
congenital glaucoma
Conventional (adult) glaucoma surgery techniquesأثبتت جراحات المياه الزرقاءdo
not work well in glaucoma of the infants. Similarly not successful
are the commonly used techniques which employ the addition of
certain chemicals which inhibits closure of the filtration
(anti-mitotic drugs). These have high
success rates in the beginning, but eventual failure and
complicaitons ensue.
A surgical
technique called trabeculotomy for the management of these
congenital glaucoma infants was introduced in the 1960s, with a
surgical target of severing a tissue called the trabecular meshwork,
which is usually obstructed in congenital glaucoma cases, and
leaving otherr tisuues intact. It showed reasonably good success
rates in those days. The instruments used for this surgery called
trabeculotomy have largely developed along past years, and with some
modifications suggested and popularized by Dr Khalil. He is claiming
a success rate of over 90% in primary cases who did not have prior
surgical interventin. This is one of the highst rates in the world,
It avoids most of the complications associated with traditional
adult surgery, as it directly hits the faulty tissue of the eye
without much interfering with other tissues
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 Successful
glaucoma surgery has been carried out for this child |
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