Neglected Congenital Glaucoma With Lens Coloboma.

PURPOSE: To report a case of lens coloboma in a case of neglected primary congenital glaucoma. MATERIALS AND METHODS: A 5-year-old boy was brought by the parents with complaints of diminution of vision in both eyes noticed for 8 months. There was a history of enlargement of eyes since 1 year of age. RESULTS: Clinical examination revealed bilateral large eyes with limbal stretching and Haab striae and lens coloboma in the right eye. Dilated examination revealed scalloped border of the crystalline lens superotemporally with broken zonules and lens coloboma in inferotemporal quadrant with absent zonules. There was advanced optic nerve head cupping in both eyes. This lens coloboma is likely an acquired condition due to extensive stretching of the lens and zonules secondary to globe enlargement in neglected buphthalmos. CONCLUSION: A neglected case of congenital glaucoma can lead to lens subluxation along with lens coloboma.

[Connatal dacryostenoses. Clinical picture and treatment]. / Konnatale Dakryostenosen. Klinik und Therapie.

Connatal dacryostenosis involves obstructions of the lacrimal passages in all parts of the system as well as supernumerary structures like the connatal fistula of the lacrimal sac. Usually intervention in infants with aplasia of the puncta is not necessary. When the lacrimal passages are involved in coloboma of the lids or facial cleft, reconstruction depends on the usable tissue of the lacrimal system. Treatment of connatal mucocele consists of digital expression of the pseudo-tumor. In cases of connatal dacryostenosis due to Hasner's membrane in infants, massage of the lacrimal sac as well as application of antibiotic eye drops and detumescent nose drops is indicated. After 5 or 6 months high-pressure irrigation with the hollow probe of Bangerter is necessary. Important is the postoperative treatment with detumescent and antibiotic eye drops as well as with detumescent nose drops for 1-2 weeks. In acute inflammation, treatment of the inflammation is the first goal of therapy, which may be combined with incision of the abscess. This can be performed by transcutaneous incision as well as by endonasal intervention in cooperation with a rhinologist.

Treacher Collins syndrome: early surgical treatment of orbitomalar malformations.

In the past various materials have been used for the correction of the malar bone defect, such as cartilage, dermis fat, silicone, autograft, homograft, xenograft, and free bone transplantation. The disadvantages of inorganic implants are well known: dislocation, extrusion, and capsular contraction. The bony autograft has no growth potential, and children may need several complementary corrections. None of these procedures is totally satisfactory. To solve these problems malar reconstruction is performed with the help of a temporal bone flap. Two varieties of these flaps have been described: one anteriorly with a muscular pedicle vascularized by the deep temporal artery and one posteriorly with a galeal pedicle vascularized by the superficial temporal artery. The main advantage of an osteomuscular flap is the survival of bone once it has been transferred. The second advantage is related to the osteogenic potential of the cambium layer of the periosteum, which may prove to be an ongoing concern. Our series of patients includes 20 children. Correction of the eyelid coloboma was obtained by transposition and advancement of a superior palpebral flap.