Reversal Of Optic Disc Cupping Research Articles

Visual outcomes and associated factors of primary congenital glaucoma in children.

We evaluated the long-term visual outcomes in children with primary congenital glaucoma and determined the factors associated with the final visual outcomes. Medical records of children with primary congenital glaucoma between 2005 and 2016, seen at Seoul National University Children's Hospital in South Korea, were reviewed. The minimum follow-up period after surgery for primary congenital glaucoma was 3years. Visual acuity (VA) was categorized into good (≧20/70) and poor (< 20/70). Factors including age, VA, refractive errors, intraocular pressure (IOP), laterality, and cup-to-disc (C/D) ratio were compared between the groups. A total of 71 eyes of 44 patients were included. The patients' age at the time of surgery was 14.7 ± 12.2months. The mean IOP was 28.3 ± 7.0mmHg. During 6.7 ± 2.7years of mean follow-up after surgery, 39 eyes (54.9%) needed occlusion treatment. After occlusion, patients with lower IOP values, lesser additional surgeries, reversal of optic disc cupping, and better initially measured VA achieved a better visual outcome. At the final assessment, the mean age was 7.8 ± 2.6years, and the mean VA gain was 15.0 ± 19.4 letters. There were 44 eyes (62.0%) with VA ≧20/70. In children with primary congenital glaucoma, IOP control and the optic disc configuration over time are important factors associated with visual outcome. Regular follow-up and correction of refractive errors-along with occlusion for those with difference in VA between the two eyes-might be helpful for achieving better visual outcomes.

Combined trabeculotomy-trabeculectomy using the modified Safer Surgery System augmented with MMC: its long-term outcomes of glaucoma treatment in Asian children.

This study aimed to study the long-term surgical outcomes of combined trabeculotomy-trabeculectomy (CTT) using the modified Safer Surgery System in treating childhood glaucoma at a tertiary medical center in Taiwan. Retrospective, consecutive, noncomparative case series. We retrospectively reviewed medical records of 42 pediatric patients (age 0-18years) who had CTT performed on their 65 eyes using the modified Safer Surgery System. The study period spanned 18years (from January 1, 1997, to December 31, 2014). We evaluated the outcome in terms of postoperative intraocular pressure (IOP), axial length growth, disc cupping reversal, and use of antiglaucoma medications. The surgical success was rated using the Kaplan-Meier survival analysis and based on the incidence of complications. The mean follow-up period was 85.05 ± 32.17months (range 14-200). After operation, IOP dropped significantly from 35.76 ± 9.44mmHg (mean ± SD) to 16.18 ± 7.20mmHg together with a significant reversal of optic disc cupping. Similarly, the use of antiglaucoma medications was also significantly reduced in number from 1.26 ± 0.50 to 0.43 ± 0.70. Most of the axial lengths of the eyes measured at the last follow-up visit showed growths within the average ± 2 SDs in comparison with the healthy, age-matched population. After surgery, the qualified success rate was 90.77% at the end of the first year, 90.77% at the second year, 87.64% at the fifth year, 84.51% at the 10th year, and 81.38% at the 15th year. No serious intraoperative or postoperative complications were found. For Taiwanese children, the combined trabeculotomy-trabeculectomy using the modified Safer Surgery System offered an efficient and safe surgical option for treating glaucoma with long-term satisfactory control of IOP.

Retraction

Objective: To evaluate which clinical parameters are the predictive factors associated with reversal of optic disc cupping in primary open-angle glaucoma. Methods: The medical records of 184 eyes of 184...

Reversal of optic disc cupping in glaucoma

Aim:To study whether reversal of optic disc cupping after intraocular pressure (IOP) reduction is related to risk of glaucoma progression.Methods:In this prospective follow-up study, where 51 patients with exfoliation glaucoma...

Cup reversal protects from glaucoma progression

Abstract Purpose: Reversal of optic disc cupping after reduction in intraocular pressure (IOP) is well documented. The effect of cup reversal on the risk of progression of glaucoma was investigated. Methods: All 80 consecutive patients referred to the Helsinki University Eye Hospital between May 1995 and May 1997 because of exfoliation glaucoma were included. They were treated medically, with laser trabeculoplasty, or surgically. Fifty‐six patients (mean age ±SD at study entry, 70 ± 7 years) were followed for 5.9 ± 0.8 years. Scanning laser opthtalmoscopy (Heidelberg Retina Tomograph, HRT) of the optic nerve head was performed before treatment and at follow up visits. A decrease of more than 5% in the HRT parameter cup volume (CV) after change in treatment was considered to be a sign of cup reversal. The effect of cup reversal on progression of glaucoma was modelled in multiple logistic regression. Results: Of 56 patients, 24 showed progression of glaucoma in visual fields or optic discs. The other 32 remained stable. IOP reduced from 21 ± 5 mmHg to 16 ± 4 mmHg (P &lt; 0.001). Presence of cup reversal was related to decreased risk of progression of glaucoma (Odds ratio [OR], 0.226; 95% CI, 0.055‐0.917, P = 0.037). The risk of progression increased with higher MD at study entry (OR, 1.158 for each dB; 95% CI, 1.034‐1.296; P = 0.011), and higher final IOP (OR, 1.216 for each mmHg; 95% CI, 1.000‐1.479; P = 0.050). The change in IOP from study entry to final IOP was not associted with progressio progression (OR, 0.964 for each mmHg; 95% CI, 0.850‐1.092, P = 0.561). Conclusions: Optic disc cupping can be reversed and sustained for years after IOP reduction. Cup reversal seemed to be an independent protective factor against progression of glaucoma.

Reversal of optic disc cupping after trabeculotomy in primary congenital glaucoma

Background: The phenomenon of reversal of glaucomatous cupping of the optic disc following lowering of the intraocular pressure (IOP) was originally recognized in infants. We evaluated the change in optic disc cupping with normalization of the IOP after trabeculotomy in primary congenital glaucoma and assessed the factors associated with reversal of cupping.Methods: We reviewed the records of 17 patients (24 eyes) who underwent trabeculotomy between July 1993 and June 1999 and who had been followed for at least I year. Surgical success was defined as IOP less than 22 mm Hg without antiglaucoma medication, stable or reduced optic disc cupping, and lack of further corneal enlargement disproportionate to normal growth. Patients who required more than one surgical procedure to control the IOP and those with cloudy media that precluded documentation of cupping were excluded from analysis. Optic disc cupping was assessed independently before and after surgery by two clinicians. The cup:disc ratio was estimated as the percentage of surface area of the optic disc occupied by cupping in the vertical axis. We accepted a difference of 0.1 or 0.2 in the cup:disc ratio between the two observers in each subjective assessment and used the mean value of the two results for data analysis. If the difference was more than 0.2, the eye was excluded from further study.Results: Of the 17 patients 4 were excluded: 2 because they received antiglaucoma medication to control the IOP postoperatively, I because he underwent more than one surgical procedure to control the IOP during follow-up, and I owing to disagreement in the assessment of the cup:disc ratio between the two observers. Eighteen eyes of 13 patients were thus included in the analysis. Twelve eyes were from boys and six, from girls. The patients were followed for a mean of 43.2 (standard deviation [SD] 30.4) months (range 12 to 90 months). The mean cup:disc ratios pre- and postoperatively were 0.74 (SD 0.20) and 0.60 (SD 0.2 I) respectively (p = 0.003). Of the 18 eyes I I (61. I %) had documented reduction in optic disc cupping. The mean time to stabilization of cupping reversal was 4.8 (SD 2.8) months (range 2 to 12 months). In multivariable analysis the age of the patient at surgery was the only variable significantly associated with reversal of cupping (p = 0.027). The mean age at surgery for the I I eyes with reduction in cupping was 6.9 (range 3 to 15) months, compared with 23.4 (range 12 to 42) months for the 7 eyes with unchanged cupping. The mean preoperative cup:disc ratio was 0.67 (SD 0.17) in the former group and 0.83 (SD 0.17) in the latter group. Six of the seven eyes with unchanged cupping had advanced cupping.Interpretation: Optic disc cupping can be reversed at an early stage of primary congenital glaucoma following successful reduction of IOP. Younger age at surgery was associated with reversal of cupping.

Reversal of optic disc cupping after glaucoma surgery analyzed with a scanning laser tomograph

Objective To detect and quantitate changes in optic nerve morphology after glaucoma surgery using the Heidelberg Retina Tomograph (HRT, Heidelberg Instruments, Heidelberg, Germany). Design Nonconsecutive observational case series. Participants and intervention The authors prospectively enrolled 21 adult patients undergoing incisional glaucoma surgery for progressive glaucoma damage. Quantitative analysis of the optic nerve head by scanning laser tomography and automated perimetry were performed before and after glaucoma surgery. Main outcome measures Changes in optic nerve parameters were subjected to linear regression analysis with respect to percent of postoperative reduction of intraocular pressure (IOP), as well as with respect to age, refraction, preoperative cup:disc ratio, and change in visual field parameters. Results Seventeen patients had pre- and postoperative images suitable for analysis. Mean IOP at the time of image acquisition before surgery was 30.5 ± 12 mmHg, and after surgery 11.8 ± 5.2 mmHg (mean follow-up, 26 ± 7 weeks). Eleven of 13 (85%) patients having IOP reduction of greater than 40% showed improvement in optic disc parameters. All four patients with less than 25% reduction in IOP showed worsening of most parameters. Changes in optic disc parameters were highly correlated with percent IOP reduction and with age. The parameters in which change most strongly correlated with percent change of IOP were cup area, rim area, cup:disc ratio, and mean cup depth (each, P < 0.005). The age of the patient correlated highly with change in maximum cup depth ( P < 0.005). Refraction and clinically determined cup:disc ratio correlated poorly with changes in measured optic disc parameters. Clinical improvement in visual fields was correlated with the degree of improvement of cup:disc ratio ( P = 0.025). Conclusion Most patients showing a 40% lowering of IOP after glaucoma surgery show improved optic nerve morphology as measured by the HRT. The amount of improvement correlated highly with the percent reduction of IOP.

Reversal of Optic Disc Cupping and Pallor in Patients with Ocular Hypertension Using Timolol Therapy

We studied the quantitative effects on optic disc cupping and pallor in a double-masked, prospective clinical trial in which patients were randomized to timolol and placebo groups.

Reversibility by timolol of optic nerve disc cupping and pallor in ocular hypertensives (summary)

study that focused on the effect of timolol on the optic disc in patients with ocular hypertension (OHT). Our investigation was concerned with the effect of timolol on optic disc cupping, as determined by photogrammetry, and pallor, evaluated by computerized image analysis.6s Cupping is a three-dimensional depression of the surface of the optic disc .4 Pallor is an important monitoring factor because of its relationship to visual field 10~s.~ Pallor also provides some indication of blood flow to the optic disc. Patients with OHT entered into this study had to have had ocular pressures ~21 mm Hg on two or more occasions without evidence of glaucomatous visual field loss. The timolol and placebo groups were matched for sex, race, iris color, intraocular pressure (IOP), blood pressure, and pulse rate. Forty-one patients meeting the criteria were randomly assigned to receive either timololO.5% or placebo drops in both eyes twice a day for 18 months. After a baseline examination, patients were observed at three-month intervals and photographs obtained for the measurement of cupping by photogrammetry11-18 and the measurement of optic disc pallor by computerized image with multiple plan points.‘” Visual fields were evaluated every six months with the Goldmann perimeter. There were progressive dropouts of individuals throughout the trial. Lack of compliance was the most frequent reason for discontinuance, although bradycardia occurred in some timolol-treated subjects. Patients with a pulse rate 160/min were dropped as a precaution. Our preliminary analysis using linear regression analysislO of all measurements of disc cupping as a function of time, irrespective of follow-up time, showed significant decreases in cup volume, with the timolol-treated eyes having a greater decrease than the placebo-treated eyes. When these data were expressed on a per-year basis, there was about a 15% net decrease in initial cup volume with timolol therapy* Similar analysis of the data obtained for disc pallor provided different results. Net average pallor decreased with timolol therapy about 8% for the right eye and 0.5% for the left eye. These changes were small, but only just statistically significant for the right eye. These results have to be confirmed by further analyses and studies, but it appears on preliminary analysis that timolol had a continuous effect on reversal of optic disc cupping for both eyes and pallor for the right eye.9 These changes are of interest, because in treating patients with OHT we were, in effect, probably intervening early in the disease and obtaining some reversal of disc parameters.