Comparative Intraoperative Anterior Segment OCT Findings in Pediatric Patients with and without Glaucoma

Abstract

To compare the angle structures during surgery using anterior segment (AS) OCT in children with and without glaucoma. Prospective comparative study, with single masked grader evaluating AS OCT images. This study included a total of 44 eyes of 8 children with glaucoma and 14 children without glaucoma undergoing ophthalmic surgery with general anesthesia. The median age for the glaucoma group was 6 months (range, 0.5-108 months), and that for the nonglaucoma group was 42 months (range, 14-95 months). An Envisu C2300 handheld OCT with a high-resolution AS lens was used to capture videos of temporal and nasal quadrant anterior chamber angles from each eye. Still images of the temporal and nasal angles were selected and then graded by a masked ophthalmologist examiner to determine whether Schlemm's canal (SC) was visible, if abnormal tissue was present in the angle, and whether intrascleral lumens were present. Clinical correlation with severity of glaucoma was performed after AS OCT images were graded. Presence or absence of SC on AS OCT in glaucomatous and nonglaucomatous eyes. Schlemm's canal was present in 7 of 13 glaucomatous eyes compared with 27 of 27 nonglaucomatous eyes. In patients with unilateral glaucoma, absence of SC was noted only in the affected eye. Eight eyes with glaucoma showed abnormal tissue over the angle and SC. Intrascleral lumen and collector channels were found in both groups. Two patients with severe stenosis of SC during glaucoma angle surgery showed absent SC on AS OCT. Intraoperative AS OCT identified differences in the presence and characteristics of SC and the anterior chamber angle in pediatric patients with and without glaucoma. Further studies are needed to determine clinical correlation.