Opinion: Dr Anil K Mandal
Congenital glaucoma needs an early intervention
Wednesday, March 7, 2018

Way back in 1988, I, as a young doctor, assisted my mentor, Prof. N N Sood, in an operation involving a new-born baby with congenital glaucoma at Dr Rajendra Prasad Centre for Ophthalmic Sciences of All India Institute of Medical Sciences, New Delhi. The surgery was performed successfully on Baby Samreen, as this infant was called.

Eight years later in 1996, Samreen was brought to the LV Prasad Eye Institute (LVPEI), Hyderabad. I was pleasantly surprised to see her again. I operated on her left eye to control the pressure and to preserve the existing vision. But unfortunately, she had lost her vision totally in the right eye by then.

With a residual eyesight of just two meters visibility in the left eye, this brave, enterprising girl did brilliantly in her studies; she scored 92 per cent marks in the 12th standard examination, completed her B. Com and stood first in her MBA examination. And now she looks after her father’s business.

At 26, in the year 2016, Samreen got married and soon after, was blessed with a perfectly healthy girl child. The baby Ayesha – meaning the blessing of almighty-- had beautiful eyes with perfectly normal vision. Samreen brought her to me last year. I felt a deep sense of happiness and fulfilment within me after I ruled out any trace of glaucoma in her eyes.

Samreen with her daughter, Ayesha, and Dr Anil Mandal

Glaucoma in kids manifests with a large corneal diameter (megalocornea), excessive tearing (epiphora) and intolerance to light (photophobia) leading to the squeezing of the eyelids (blepherospasm).The cornea loses its transparency and becomes bluish or whitish. The pressure within the eye becomes high and leads to the damage of the optic nerve. If not treated early, it can lead to blindness.

Congenital glaucoma is a disease, which requires surgery at an early age, sometimes multiple surgical interventions, as in the case of Baby Samreen. I have operated several children within one week of age and the youngest child operated by me was three days old. The surgical technique helps to restore the outflow facility of the fluid from the eye so that the pressure within the eye is normalized. This helps in the restoration of corneal clarity and prevents the permanent damage to the optic nerve. Periodic evaluation of the child is required and optical correction should be provided as early as possible so that the afflicted child gets the best opportunity for the development of good vision in both eyes. Lifelong follow up is a must for every afflicted child.

Patients of paediatric glaucoma should opt for a Braille system education and go for visual rehabilitation services.  Genetic aspects of the disease should be discussed and genetic counselling provided. Marriage within the close relatives for example maternal uncle to niece and second cousin marriage should be avoided from the genetic point of view. Lifelong follow-up is a must for every afflicted child.

I have operated on more than 2,000 children in the last 30 years.

The writer is Senior Consultant, Jasti V Ramanamma Children's Eye Care Centre and Consultant, L V Prasad Eye Institute, Hyderabad   

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