Axial Length Changes Following Surgical Intervention in Children With Primary Congenital Glaucoma.

Hind A Al Dalgan,Khabir Ahmad,Rizwan Malik,Adi M Al Owaifeer,Ibrahim A Al Obaida

doi:10.3389/fopht.2021.747801

Hind A Al Dalgan, Khabir Ahmad + Show 3 more

Open Access

https://doi.org/10.3389/fopht.2021.747801

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Abstract

Primary congenital glaucoma (PCG) is a challenging condition to diagnose, treat and effectively monitor. Serial assessment of intraocular pressure (IOP), optic disc cupping, refraction, and axial length (AxL) after surgery are useful to assess disease control. This study aimed to evaluate AxL changes in relation to IOP changes following glaucoma surgery in children with PCG. We retrospectively studied AxL changes in children with PCG undergoing surgery. Eyes of children aged ≤ 4 years that did not have prior ocular surgery and that underwent at least one glaucoma surgery during the course of follow-up between June 2014 and July 2018, were included. The effect of change in IOP on change in AxL was estimated using linear mixed effects models. A total of 105 eyes (of 72 children) with PCG underwent glaucoma surgery representing 26.4% (105/397) eyes. The mean ± SD age of children at baseline was 3.53± 4.04 months. At baseline, the mean IOP and AxL were 26.63 ± 9.57 mmHg and 21.67 ± 1.82mm, respectively. During the course of follow-up post-surgery, the IOP decreased by a mean of 7.25 ± 12.08 mmHg while the AxL increased by a mean of 0.70 ± 1.40mm. A multivariable mixed effects linear regression revealed that change in AxL was significantly associated with change in IOP (p=0.030) and time since first surgery (p<0.001). A substantial reduction in IOP (≥35 mmHg) was needed at 3 months post-surgery, for AxL to regress. In children with PCG who undergo glaucoma surgery, change in IOP significantly influences change in AxL. For AxL to regress, a substantial reduction in IOP is needed post-surgery.

Highlights

Congenital glaucoma is one of the major causes of blindness during childhood [1]. It is characterized by elevated intraocular pressure (IOP), optic nerve damage and globe enlargement manifested as buphthalmos, increased corneal diameter and increased axial length (AxL) [2]
We recently reported findings of one of the largest studies (n=397 phakic eyes of 208 children) to assess the relationship of axial length, and age in children with primary congenital glaucoma [16], but that study did not quantify the effect of surgery on AxL
AxL measurement can be performed under sedation or anesthesia and is a valuable tool in the diagnosis and followup, as a long-term parameter for disease control in children with congenital glaucoma [11, 14]

Summary

Introduction

Congenital glaucoma is one of the major causes of blindness during childhood [1]. It is characterized by elevated IOP, optic nerve damage and globe enlargement manifested as buphthalmos, increased corneal diameter and increased axial length (AxL) [2].Primary congenital glaucoma (PCG) is the most common form of congenital glaucoma. Congenital glaucoma is one of the major causes of blindness during childhood [1]. It is characterized by elevated IOP, optic nerve damage and globe enlargement manifested as buphthalmos, increased corneal diameter and increased axial length (AxL) [2]. Primary congenital glaucoma (PCG) is the most common form of congenital glaucoma. It is a developmental eye disorder due to an isolated maldevelopment of anterior chamber angle, the major site of aqueous humor drainage, without an identifiable ocular or systemic mechanism.

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