Yun Hsia1,2, Tso-Ting Lai1,3, Chien-Chia Su1, Tsing-Hong Wang1, Jehn-Yu Huang4. 1. Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, 100, Taiwan. 2. National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan. 3. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. 4. Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, 100, Taiwan. jehnyuhuang@ntu.edu.tw.
Abstract
PURPOSE: To investigate the clinical characteristics and long-term outcomes of primary congenital glaucoma (PCG) patients. METHODS: In this retrospective, longitudinal, cohort study, PCG patients with reliable visual field (VF) tests and optical coherence tomography (OCT) were included. Disease progression was detected using guided progression analysis with OCT and the change analysis of mean deviation (MD) slope with VF tests. Factors associated with the disease progression and visual prognosis were analyzed. RESULTS: Twenty-nine eyes from 11 bilateral and 7 unilateral PCG patients were enrolled. LogMAR visual acuity declined (0.15 vs. 0.40, P < 0.001). The change rate of the average retinal nerve fiber layer thickness was - 0.83 ± 1.45 µm/year, and 28% of eyes showed glaucoma progression on OCT. The median of the MD slope was 0.16 (- 1.19 to 1.07) dB/year, and 14% of eyes showed glaucoma progression on the VF test. Higher average intraocular pressure (IOP) (P = 0.046) and IOP fluctuation (P = 0.031) predicted disease progression. None of the fellow eyes of unilateral PCG patients developed glaucoma during the follow-up. At last, 59% of eyes had visual acuity > 20/70, and 31% had MD > - 6 dB. Patients with worse baseline visual acuity (P = 0.027), worse baseline MD (P < 0.001), and smaller neuroretinal rim area (P < 0.001) showed worse final MD values. CONCLUSIONS: Aggressive IOP control is necessary to prevent structural and functional decline in PCG patients. Their fellow eyes are not at risk of glaucoma. Baseline neuroretinal rim area can predict the functional outcome.
PURPOSE: To investigate the clinical characteristics and long-term outcomes of primary congenital glaucoma (PCG) patients. METHODS: In this retrospective, longitudinal, cohort study, PCG patients with reliable visual field (VF) tests and optical coherence tomography (OCT) were included. Disease progression was detected using guided progression analysis with OCT and the change analysis of mean deviation (MD) slope with VF tests. Factors associated with the disease progression and visual prognosis were analyzed. RESULTS: Twenty-nine eyes from 11 bilateral and 7 unilateral PCG patients were enrolled. LogMAR visual acuity declined (0.15 vs. 0.40, P < 0.001). The change rate of the average retinal nerve fiber layer thickness was - 0.83 ± 1.45 µm/year, and 28% of eyes showed glaucoma progression on OCT. The median of the MD slope was 0.16 (- 1.19 to 1.07) dB/year, and 14% of eyes showed glaucoma progression on the VF test. Higher average intraocular pressure (IOP) (P = 0.046) and IOP fluctuation (P = 0.031) predicted disease progression. None of the fellow eyes of unilateral PCG patients developed glaucoma during the follow-up. At last, 59% of eyes had visual acuity > 20/70, and 31% had MD > - 6 dB. Patients with worse baseline visual acuity (P = 0.027), worse baseline MD (P < 0.001), and smaller neuroretinal rim area (P < 0.001) showed worse final MD values. CONCLUSIONS: Aggressive IOP control is necessary to prevent structural and functional decline in PCG patients. Their fellow eyes are not at risk of glaucoma. Baseline neuroretinal rim area can predict the functional outcome.
Entities:
Keywords:
Glaucoma progression; Optical coherence tomography; Primary congenital glaucoma; Visual field test
Authors: Sophia L Zagora; Charlotte L Funnell; Frank J Martin; James E H Smith; Stephen Hing; Francis A Billson; Anne-Sophie Veillard; Robyn V Jamieson; John R Grigg Journal: Am J Ophthalmol Date: 2015-01-26 Impact factor: 5.258