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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7962
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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hi doctor how are you this is david, my daughter is 40 months

Resolved Question:

hi doctor
how are you
this is david, my daughter is 40 months now,
when she is born, have port wine stains in right top of eye and right brain surface,
1.seizures ,when her 8 months old, and 33months happen again.
when 33months, we made CT scan and MRI for the port wine area, show brain atrophy on the port wine stains side ,
.now the port wine eye have vision problem,have glaucoma illness ,(we plan to go to shanghai make a surgey this week)
present time, there don't have muhc more treatment in china, just Drug therapy control with ,"Keppra" Levetiracetam from Belgim,(every day 2 times ,morning and evening before sleeping)
, i worry too much with her age growing become more worse.
i am truly wish if there have any good way in USA,

Thank you very much and appreciated for all your help.
David
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick : Hi. I'm online and happy to answer your question today.
Dr. Rick : Glaucoma secondary to the dermal capillary vascular abnormalies found in Sturge-Weber syndrome can be very, very difficult to treat.
Dr. Rick : The primary cause of increased intraocular pressure in patients such as your daughter are usually secondary to anomalies of the front part of the eyeball (anterior chamber and outflow channels), especially when they occur before one year old.
Dr. Rick : In children who first present with the port wine stain and elevated eye pressure after one year of age, the abnormalities usually involve problems with elevated episcleral venous pressure rather then anatomical malformations of the eyeball itself.
Dr. Rick : In any event it is important to lower her eye pressure as soon as possible. In patients such as your daughter surgery, rather than eye drops, is the first step in controlling her glaucoma.
Dr. Rick : In many cases eye drops are needed to keep the pressure low enough, even after surgery...
Dr. Rick : Why is it so important to have the glaucoma treated as soon a you can? That is because any vision lost to the disease can never be restored. All the surgery/drops can do is prevent future loss of vision.
Dr. Rick : What surgery is usually done for children like your daughter? There are two common procedures: Trabeculectomy and trabeculotomy.
Dr. Rick : Sometimes goniotomy can be tried although it may not be as successful in Sturge-Webber associated glaucoma....
Dr. Rick : Here is a good webpage that discusses childhood glaucoma in more detail:
Dr. Rick : http://www.chop.edu/healthinfo/childhood-glaucoma.html
Dr. Rick : A study in the medical journal Ophthalmology a few years ago looked at the treatment of patients like your daughter with glaucoma. They found that in patients with early onset glaucoma (which your daughter has) did best when they were treated using a combined trabeculotomy-trabeculectomy.
Dr. Rick : Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction
Dr. Rick : I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.Thanks in advance,Dr. Rick MD FACS
Expert:  Dr. Rick replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

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If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Rick replied 1 year ago.
David,

Please allow me to repost our chat here for your review since you are offline. Since I am in the USA, on the other side of the world from you, we probably will not be online together very often:


Dr. Rick : Hi. I'm online and happy to answer your question today.
Dr. Rick : Glaucoma secondary to the dermal capillary vascular abnormalities found in Sturge-Weber syndrome can be very, very difficult to treat.
Dr. Rick : The primary cause of increased intraocular pressure in patients such as your daughter are usually secondary to anomalies of the front part of the eyeball (anterior chamber and outflow channels), especially when they occur before one year old.
Dr. Rick : In children who first present with the port wine stain and elevated eye pressure after one year of age, the abnormalities usually involve problems with elevated episcleral venous pressure rather then anatomical malformations of the eyeball itself.
Dr. Rick : In any event it is important to lower her eye pressure as soon as possible. In patients such as your daughter surgery, rather than eye drops, is the first step in controlling her glaucoma.
Dr. Rick : In many cases eye drops are needed to keep the pressure low enough, even after surgery...
Dr. Rick : Why is it so important to have the glaucoma treated as soon a you can? That is because any vision lost to the disease can never be restored. All the surgery/drops can do is prevent future loss of vision.
Dr. Rick : What surgery is usually done for children like your daughter? There are two common procedures: Trabeculectomy and trabeculotomy.
Dr. Rick : Sometimes goniotomy can be tried although it may not be as successful in Sturge-Webber associated glaucoma....
Dr. Rick : Here is a good webpage that discusses childhood glaucoma in more detail:
Dr. Rick : http://www.chop.edu/healthinfo/childhood-glaucoma.html
Dr. Rick : A study in the medical journal Ophthalmology a few years ago looked at the treatment of patients like your daughter with glaucoma. They found that in patients with early onset glaucoma (which your daughter has) did best when they were treated using a combined trabeculotomy-trabeculectomy.
Dr. Rick : Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction
Dr. Rick : I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.Thanks in advance,

Dr. Rick MD FACS

I wish your daughter the very best :)
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7962
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 1 year ago.
David,

Please allow me to repost our chat here for your review since you are offline. Since I am in the USA, on the other side of the world from you, we probably will not be online together very often:


Dr. Rick : Hi. I'm online and happy to answer your question today.
Dr. Rick : Glaucoma secondary to the dermal capillary vascular abnormalities found in Sturge-Weber syndrome can be very, very difficult to treat.
Dr. Rick : The primary cause of increased intraocular pressure in patients such as your daughter are usually secondary to anomalies of the front part of the eyeball (anterior chamber and outflow channels), especially when they occur before one year old.
Dr. Rick : In children who first present with the port wine stain and elevated eye pressure after one year of age, the abnormalities usually involve problems with elevated episcleral venous pressure rather then anatomical malformations of the eyeball itself.
Dr. Rick : In any event it is important to lower her eye pressure as soon as possible. In patients such as your daughter surgery, rather than eye drops, is the first step in controlling her glaucoma.
Dr. Rick : In many cases eye drops are needed to keep the pressure low enough, even after surgery...
Dr. Rick : Why is it so important to have the glaucoma treated as soon a you can? That is because any vision lost to the disease can never be restored. All the surgery/drops can do is prevent future loss of vision.
Dr. Rick : What surgery is usually done for children like your daughter? There are two common procedures: Trabeculectomy and trabeculotomy.
Dr. Rick : Sometimes goniotomy can be tried although it may not be as successful in Sturge-Webber associated glaucoma....
Dr. Rick : Here is a good webpage that discusses childhood glaucoma in more detail:
Dr. Rick : http://www.chop.edu/healthinfo/childhood-glaucoma.html
Dr. Rick : A study in the medical journal Ophthalmology a few years ago looked at the treatment of patients like your daughter with glaucoma. They found that in patients with early onset glaucoma (which your daughter has) did best when they were treated using a combined trabeculotomy-trabeculectomy.
Dr. Rick : Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction
Dr. Rick : I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.Thanks in advance,

Dr. Rick MD FACS

I wish your daughter the very best :)
Expert:  Dr. Rick replied 1 year ago.
Hi David,

I was just thinking about your daughter and wondering how she was doing. Did she have here eye surgery yet? If so, I hope things went well and her pressure is well controlled.

Take care and let me know if I can do anything else to help you in the future.

Dr. Rick

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