Congenital cataract and glaucoma — branching viva

Branching structured-oral viva on congenital cataract and glaucoma: the red-reflex test and the leukocoria differential including retinoblastoma; deprivation amblyopia and the critical-period surgical window for dense unilateral (by ~6 weeks) and bilateral (by 6 to 10 weeks) cataract; the Infant Aphakia Treatment Study on aphakia versus primary IOL; lifelong aphakic glaucoma surveillance; the primary congenital glaucoma triad of epiphora, photophobia and blepharospasm with buphthalmos and Haab striae; the angle-surgery ladder from goniotomy to 360-degree trabeculotomy to tubes; and the drugs to avoid in the infant eye including brimonidine.

branching clinical structured oral4 min readVerification in progress

Prompt

You are the general paediatric registrar in clinic. A 4-week-old infant is found to have an absent red reflex and a dense white opacity in the left pupil; the right eye is normal. The examiner asks you to take the candidate through the urgency, the surgical decision, and the long-term complications, then branches into the glaucoma triad and its management.

Opening (examiner)

A 4-week-old term infant is referred by the child-health nurse because the left pupil looked white. On your red-reflex test the left reflex is absent. The right eye is normal. Take me through your assessment and your immediate management. ^[11]

References5Show

[2]Biglan AW Glaucoma in children: are we making progress? J AAPOS, 2006.PMID 16527674
[5]Freedman SF; Lynn MJ; Beck AD; et al Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study. JAMA Ophthalmol, 2015.PMID 25996491
[8]Abbas J; Haider F; Arooj H; et al Comparison of 360-Degree Trabeculotomy Versus Traditional Angle Surgery in Primary Congenital Glaucoma: A Systematic Review and Meta-Analysis. J Glaucoma, 2026.PMID 41875194
[11]Toli A; Perente A; Labiris G Evaluation of the red reflex: An overview for the pediatrician. World J Methodol, 2021.PMID 34631483
[12]Anderson J Don't Miss This! Red Flags in the Pediatric Eye Examination: Abnormal Red Reflex. J Binocul Vis Ocul Motil, 2019.PMID 31329054

Congenital cataract and glaucoma — branching viva

branching clinical structured oral4 min readVerification in progress

Opening (examiner)

References5Show

[2]Biglan AW Glaucoma in children: are we making progress? J AAPOS, 2006.PMID 16527674
[5]Freedman SF; Lynn MJ; Beck AD; et al Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study. JAMA Ophthalmol, 2015.PMID 25996491
[8]Abbas J; Haider F; Arooj H; et al Comparison of 360-Degree Trabeculotomy Versus Traditional Angle Surgery in Primary Congenital Glaucoma: A Systematic Review and Meta-Analysis. J Glaucoma, 2026.PMID 41875194
[11]Toli A; Perente A; Labiris G Evaluation of the red reflex: An overview for the pediatrician. World J Methodol, 2021.PMID 34631483
[12]Anderson J Don't Miss This! Red Flags in the Pediatric Eye Examination: Abnormal Red Reflex. J Binocul Vis Ocul Motil, 2019.PMID 31329054