Impacto visual desde el obordaje oftálmico y contactológico en paciente pediátrica con miopía alta degenerativa secundaria a glaucoma congénito primario 2025-2026: Reporte de caso

Abstract

Introduction: Primary congenital glaucoma is an early-onset condition caused by an abnormality in the development of the iridocorneal angle, leading to a sustained increase in intraocular pressure and progressive optic nerve damage. Clinically, it manifests with photophobia, epiphora, and enlargement of the eyeball, with an increase in corneal diameter, requiring differential diagnosis with primary megalocornea. Intraocular pressure is the main modifiable risk factor, and its prolonged elevation can induce structural changes associated with high myopia, anisometropia, and amblyopia; therefore, its management must be comprehensive. Objective: To determine the visual impact between the use of ophthalmic correction and contact lenses in a pediatric patient with high degenerative myopia secondary to GCP Methodology: A descriptive observational case report study was conducted on an 11-year-old female patient with a relevant ophthalmological and surgical history. The evaluation included a comprehensive assessment in optometry and ophthalmology, supported by specialized examinations such as corneal tomography (Pentacam HR), ocular biometry (Lenstar 900), optical coherence tomography (Maestro 2), and endothelial cell count (CEM-530). Soft and rigid gas permeable contact lenses were fitted, taking into account corneal characteristics and visual needs. Discussion: The endothelial assessment prior to lens fitting showed cell density, hexagonality, and coefficient of variation within normal ranges for age, with no findings consistent with glioblastoma or associated with dry eye, allowing for lens fitting under multidisciplinary follow-up. Optical coherence tomography OCT interpretation was limited by the high axial length, nystagmus, and low signal quality, factors that may have underestimated the refractive error of the lens. The standard deep-pencil lenses LCRGP were not tolerated; the custom-fitted contact lenses LCB improved visual acuity, reduced nystagmus, and offered greater comfort. Furthermore, they had a positive impact on self-esteem, posture, and social integration.