Juvenile glaucoma and high myopia: about a case

Introduction: Juvenile glaucoma is a rare form of childhood glaucoma due to a developmental abnormality of the trabecular tract but to a lesser degree than that seen in congenital glaucoma. High myopia corresponds to a refractive myopia greater than -6.00 diopters or an ocular axial length greater than 26 mm. It is a risk factor for the onset and worsening of juvenile glaucoma and this risk increases with the degree of myopia. We report a case of juvenile glaucoma associated with high myopia and myopic astigmatism in order to describe the clinical aspects and the management carried out in our context. Clinical case: This was a 5-year-old boy, with no particular medical history, who was seen for a visual impairment observed about a year ago. The slit lamp examination had found a megalocornea, a partial corneal dystrophy, in both eyes. Examination under general anesthesia had found a corrected intraocular pressure under sevoflurane estimated at 26 mmHg in the right eye and 28 mmHg in the left eye on Goldmann's portable tonometer, a horizontal and vertical corneal diameter of 13.5 mm in the right eye and 13 mm in the left eye. The fundus at the level of both eyes showed a cup to disk ratio equal to 9/10 in the right eye and 8/10 in the left eye, a nasal rejection of the papillary vessels, a macular area without particularity in both eyes. Subcycloplegic refraction found strong myopia associated with myopic astigmatism of -13 (-2) 30° in the right eye and -12 (-4) 80°. We have retained the diagnosis of juvenile glaucoma associated with high myopia and myopic astigmatism. Conclusion: High myopia is an aggravating factor in juvenile glaucoma, the risk increases with the degree of myopia. In the event of a delay in diagnosis and treatment, the progression is to glaucomatous optic atrophy.