Differences in Optic Disc Characteristics of Primary Congenital Glaucoma, Juvenile, and Adult Onset Open Angle Glaucoma Patients.

OBJECTIVE: To comparatively evaluate morphometric features of the optic discs of primary congenital glaucoma (PCG), juvenile onset primary open angle glaucoma (JOAG), and adult onset primary open angle glaucoma (POAG) using scanning laser ophthalmoscopy (HRT3). METHODS: Optic discs of previously treated 89 PCG, 136 JOAG, and 139 adult onset POAG patients, were evaluated. One eye of each patient was analyzed in the study.The optic disc characteristics studied included disc area, cup area, rim area, cup depth, cup volume, cup to disc area ratio, horizontal cup to disc ratio, vertical cup to disc ratio, and mean retinal nerve fiber layer (RNFL). A regression analysis was performed to assess the effect of age, sex, and disc area on the disc characteristics in the 3 categories of primary glaucomas. RESULTS: Mean disc area of PCG, JOAG and POAG eyes was 2.58±0.75, 2.61±0.51, and 2.44±0.58 mm, respectively. The cup characteristics that demonstrated significantly greater means among JOAG compared with POAG and PCG eyes, included cup depth (P=0.001), cup volume (P=0.024), and cup to disc area ratio (P=0.049). The mean horizontal cup to disc ratio=0.73 was greater than mean vertical cup to disc ratio=0.61 (P=0.026) among PCG eyes as well as among JOAG eyes (P=0.001). For POAG, the mean horizontal cup to disc ratio=0.73 was not different from the mean vertical cup to disc ratio=0.69 (P=0.077). CONCLUSIONS: The optic discs of juvenile onset open angle glaucoma tend to be larger in size than adult onset POAG discs. A 3-dimensional enlargement of the cup is seen among treated JOAG discs compared with POAG and PCG eyes. The greater horizontal cup disc ratio in PCG and JOAG compared with POAG eyes indicates a concentric enlargement of the cup in these patients.

Aniridic Glaucoma: Long-term Visual Outcomes and Phenotypic Associations.

PURPOSE: The aim of this study was to evaluate long-term visual outcomes in patients with aniridic glaucoma. DESIGN: Retrospective noncomparative observational case series. MATERIALS AND METHODS: A review of medical records of 128 eyes of 64 consecutive patients with aniridic glaucoma, diagnosed after the age of 5 years was analyzed. The parameters studied included age at presentation, family history, baseline intraocular pressure (IOP), type and the number of surgical interventions, and associated comorbidities. PRIMARY OUTCOME MEASURE: Best corrected visual acuity (BCVA) in the better eye. RESULTS: Mean age at presentation was 15.86±10.11 years (range, 5 to 47 y). The average follow-up was 7.69±4.98 years (range, 1 to 17 y). At the final follow up only 18 patients had BCVA better than 6\60 and only 5 patients had BCVA of >6/18. Seventeen of the 64 (26.5%) patients developed phthisis in 1 eye. The final visual outcomes were not associated with age at presentation (P=0.64) or sex (P=0.76); however, those with a higher baseline IOP (P=0.017), those with familial aniridia (P=0.037), and those who underwent more number of surgical interventions had poorer visual outcomes (P=0.004). Kaplan-Meier analysis demonstrated the probability of bilateral blindness to be 69.8% and 97.6% at 5 and 10 years, respectively. CONCLUSIONS: Long-term visual outcomes after therapy among aniridic glaucoma patients remain poor. Higher baseline IOP, the presence of familial aniridia, and a history of greater number of surgical interventions are associated with poorer long-term visual outcomes.