Congenital Glaucoma

A 3-month-old male infant born to non-consanguineous parents presents to the pediatric ophthalmology clinic with excessive tearing and light sensitivity noticed by the mother over the past 4 weeks. On examination, the infant is irritable and has a cloudy left cornea. Intraocular pressure (IOP) measured under general anesthesia is 28 mmHg in the left eye and 14 mmHg in the right eye. Gonioscopy reveals an underdeveloped trabecular meshwork with a prominent Schwalbe's line. Axial length of the left eye is 24 mm. What is the most likely diagnosis?

A 6-week-old female infant is brought to the eye clinic by her mother with complaints of excessive tearing and eye redness since birth. On examination, the right eye shows corneal haziness, mild horizontal nystagmus, and the left eye appears relatively normal. Ultrasound B-scan of the right eye shows an axial length of 24 mm (normal for age: 16–17 mm). Applanation tonometry under general anaesthesia reveals IOP of 32 mmHg in the right eye and 14 mmHg in the left eye. Gonioscopy shows a prominent Schwalbe's line with anterior displacement of the ciliary body in the right eye. What is the most likely aetiology of this infant's glaucoma?

A 3-month-old male infant born to non-consanguineous parents presents to the pediatric ophthalmology clinic with progressive enlargement of the left eye noticed by the mother over the past 6 weeks. On examination, the infant is irritable and photophobic. The left eye shows blepharospasm, epiphora, and corneal haziness. Intraocular pressure measured under general anesthesia is 28 mmHg in the left eye (normal <16 mmHg in infants). Gonioscopy reveals a high insertion of the iris root with incomplete development of the trabecular meshwork. Fundoscopy shows optic disc cupping with a cup-to-disc ratio of 0.7. What is the most likely diagnosis?

A 6-week-old female infant born to consanguineous parents is brought to the emergency department with a 2-week history of progressive eye enlargement, persistent crying, and reluctance to open the eyes. The mother reports that the infant's left eye appears larger than the right. On examination, both eyes show corneal clouding, but the left eye is markedly more affected with buphthalmos. Intraocular pressure (measured under sedation) is 32 mmHg in the left eye and 18 mmHg in the right eye. Ultrasound B-scan shows increased axial length of the left eye (24 mm vs. 20 mm on the right). Gonioscopy reveals a Barkan membrane in the left eye. Which of the following is the most appropriate next step in management?

Which of the following is the primary embryological defect in congenital glaucoma?