Better Functional Outcomes With Infantile Primary Congenital Glaucoma

By Reuters Staff

January 09, 2020

NEW YORK (Reuters Health) - Long-term functional outcomes of primary congenital glaucoma are better with infantile than with neonatal subtypes, researchers from India report.

Primary congenital glaucoma (PCG) - that is, glaucoma occurring before 3 years of age - is treated with a variety of surgical approaches to control intraocular pressure (IOP) with the aim of preserving the patient's visual acuity. It remains unclear whether outcomes differ between children diagnosed with PCG within the first month of life (neonatal PCG) and those diagnosed later (infantile PCG).

Dr. Viney Gupta and colleagues of All India Institute of Medical Sciences, in New Delhi, compared long-term visual outcomes of 140 PCG patients (235 eyes) who had undergone combined trabeculotomy-trabeculectomy (CTT) at least five years earlier.

Overall, after a median follow-up of 127 months, 37.9% of eyes had good visual acuity, 17.4% had fair visual acuity (between 6/60 and 6/18), and 44.7% had poor visual acuity (6/60 or worse), the team reports in the British Journal of Ophthalmology.

Significantly more children with infantile PCG (44.80%) than with neonatal PCG (26.70%) had good visual acuity at follow-up (p=0.017), but visual outcomes did not differ significantly between children with bilateral versus unilateral PCG.

In Kaplan-Meier survival analyses, visual acuity was significantly better in the infantile group than in the neonatal group at all time points, and visual acuity was better in the group with bilateral PCG than in the group with unilateral PCG.

Amblyopia was the most common reason for poor visual outcomes, and visual acuity gradually worsened with time in both groups of children.

"Since no study has evaluated long-term visual outcomes on this large a cohort, we believe that the results of this study are significant when counseling patients of these children and would enable the treating surgeons to improve management to get better outcomes," the authors conclude.

Dr. Gupta did not respond to a request for comments.

SOURCE: British Journal of Ophthalmology, online December 23, 2019.