Optic nerve head recovery following the intraocular pressure – lowering surgery in the eye with early juvenile glaucoma – nine-year follow-up

Abstract

Introduction. Congenital uveal ectropion (CEU) is a rare, non-progressive condition often accompanied with eyelid ptosis, anterior insertion of the iris, disgenesis of the irido-corneal angle and glaucoma. Case report. We present a case of a seven-year-old girl with a congential unilateral uveal ectropion and a secondary glaucoma which had daily variations from 13 up to 50 mm Hg. The patient had no other abnormalities of the iris or underlying systemic diseases. Introduced local anti-glau­comatous therapy initially normalized intraocular pres­sure (IOP), but failed to provide long term normalisa­tion. Trabeculectomy normalized the IOP which re­sulted in the reduction of the cup/disc ratio and restitu­tion of neuroretinal rim. The rim area increased to 1.716 mm² (0.958 mm² preoperative) rim volume, was 0.666 mm³ (0.195 mm³ preoperative) while cup-disc (C/D) ra­tio decreased to 0.330 (0.626 preoperative) as well as lin­ear C/D=0.574 (0.791 preoperative). Neuroretinal rim (NR) was preoperatively preserved in the Ti segment, damaged in T, Ts, N, Ns segments, and borderline in the Ni segment. Postoperatively, neuroretinal rim was preserved in all segments. Conclusion. In the presented case trabeculectomy induced recovery of the nerve tis­sue of the optic nerve head which was confirmed by Haidelberg Retina Tomograph II (HRT II). The treat­ment results have been maintained during the follow-up period of nine years without topical or systemic anti­glaucomatous therapy. Although CEU is a non-progres­sive and benign eye disease, associated glaucoma can cause severe optic nerve damage if not detected early and treated properly. As can be seen in the presented case, an adequate treatment can prevent and even re­verse optic disc neuropathy.