Glaucoma congenito
Il glaucoma congenito si manifesta alla nascita ed è legato ad anomalie della migrazione e differenziazione delle cellule della cresta neurale. E’ legato ad un problema di riassorbimento del mesoderma. Il glaucoma infantile è una patologia rara e può interessare uno o entrambi gli occhi.
Colpisce un neonato su 10000 nati, è più frequente nei consanguinei, esiste inoltre una familiarità, Sia ha presenza della membrana mesodermica che copre le strutture dell’angolo e che determinano aumento della IOP ( pressione intraoculare). L ‘occhio del neonato è molto plastico, cioè non ha strutture molto rigide, per cui l’aumento della pressione porta ad un aumento della dimensione dell’occhio e una delle caratteristiche principali di questi neonati è il buftalmo. Il buftalmo si può accompagnare a tutta una serie di altre condizioni patologiche che sono la:
– sublussazione o lussazione del cristallino
– rottura della Descemet (le strie di Haab)
– edema corneale
– escavazione papillare precoce che trovando nel bambino un sistema nervoso ancora molto plastico entro certi limiti è suscettibile di un recupero funzionale.
Sintomatologia
– sofferenza
– occhio lacrimoso
– fotofobia a volte accompagnata da blefarospasmo come meccanismo di difesa a questo stimolo
– frequenti ammiccamenti.
Questo quadro rappresenta una condizione molto grave che va affrontata facendo uno studio in narcosi dell’angolo camerulare, utilizzando particolari lenti che permettono l’esame dell’angolo, per poi effettuare l’intervento di goniotomia che consiste nel sezionare con una lama speciale la membrana embrionaria anormalmente persistente che ostruisce l’angolo iridocorneale e determina un aumento della pressione intraoculare.
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