Visual Outcome in Children With Congenital Glaucoma

Min Wook Chang; Yong Yeon Kim; Seung Hyun Kim

doi:10.3341/jkos.2009.50.5.743

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Chang, Kim, and Kim: Visual Outcome in Children With Congenital Glaucoma

Original Article

J Korean Ophthalmol Soc 2009;50(5):743-748.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.5.743

Visual Outcome in Children With Congenital Glaucoma

Min Wook Chang, MD, Yong Yeon Kim, MD, PhD, Seung Hyun Kim, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Seung Hyun Kim, MD, PhD Department of Ophthalmology, Ansan Hospital, Korea University College of Medicine #516 Gojan-dong, Danwon-gu, Ansan 425-707, Korea Tel: 82-31-412-5160, Fax: 82-31-412-5802, E-mail: ansaneye@hanmail.net

Received 7 August 2008 Accepted 4 February 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the prognosis of vision and the development of amblyopia in primary congenital glaucoma patients.

Methods

The author reviewed 38 eyes of 22 primary congenital glaucoma patients and evaluated variables such as age at time of surgery and at the last visit, preoperative IOP, Cup-to-disc(CD) ratio, corneal diameter, refractive error, axial lengths and IOP, CD ratio and visual acuity at the last visit. According to visual acuity, the patients were divided into 3 groups, good (＞0.5), fair (0.1∼0.5), and poor (＜0.1). The amblyopia was defined when BCVA was below 0.8 and no evidence of progression of glaucoma. There were 4 types of amblyopia: deprivation, anisometropic, strabismic and organic. The author compared the 3 groups and evaluated factors affecting the vision as well as the prevalence of amblyopia.

Results

There were 17 eyes in the good group, 4 eyes in the fair group and 17 eyes in the poor group (p＜0.05). Amblyopia developed in 17 eyes with 7 eyes showing deprivation amblyopia. Anisometropic and organic amblyopia were each found in 4 eyes, and strabismic amblyopia was found in 2 eyes. The postoperative IOP and CD ratio and preoperative CD ratio were significantly lower in the good group than the other groups (p＜0.05).

Conclusions

Final VA was poor in 45% of eyes with primary congenital glaucoma, and amblyopia developed in 45% of these eyes. The prognosis for vision may be related to the treatment of glaucoma and amblyopia.

Keywords: Amblyopia, CD ratio, IOP, Primary congenital glaucoma, Visual acuity

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Figure 1.

The prevalence of amblyopia.

Figure 2.

The prevalence of amblyopia in each group.

Table 1.

Comparison of patients profiles between three groups based upon visual acuity

	Poor	Fair	Good	p-value
Sex (M:F)	11:6	1:3	10:7	0.349^*
Eyes (OD:OS)	10:7	2:2	7:10	0.589^*
Type of surgery				1.000^*
Trabeculotomy	12	3	11	
Trabeculectomy	4	1	5	
Both	1	0	1	
Number of surgery	1.41±0.71	1.80±1.78	1.72±0.82	0.549^†
Age at surgery (mon)	31.5±45.5	3.3±2.2	30.4±40.2	0.448^†
Follow-up (mon)	88.6±83.8	105.0±85.21	124.2±67.7	0.411^†
Age at last visit (yr)	9.7±8.5	9.0±7.1	12.5±5.9	0.462^†
Total (n)	17	4	17	

^* Pearson's chi-square test

^† ANOVA test. Visual acuity: Poor<0.1, Fair 0.1∼0.5, Good>0.5.

Table 2.

Comparison of intraocular pressure and CD ratio between three groups

	Poor	Fair	Good	p-value^*
Preop IOP^† (mmHg)	32.34±11.47	29.75±7.59	29.53±11.61	0.770
Postop IOP (mmHg)	20.13±11.42	15.25±4.50	12.71±3.06	0.039
Preop CD^‡	0.81±0.20	0.63±0.15	0.62±0.22	0.035
Postop CD	0.85±0.23	0.35±0.07	0.53±0.25	0.002
Axial length (mm)	24.83±3.98	20.73±1.15	24.81±3.17	0.308
Corneal diameter (mm)	12.93±1.45	12.12±0.85	13.01±0.51	0.351

^* ANOVA test

^† IOP=intra ocular pressure

^‡ CD=cup to disc ratio.

Visual acuity=Poor<0.1, Fair 0.1∼0.5, Good>0.5.

Table 3.

Comparison of intraocular pressure and CD ratio between 2 groups

	Good	Others	p-value^*
Preop IOP^† (mmHg)	29.53±11.61	31.76±10.72	0.542
Postop IOP (mmHg)	12.71±3.06	19.11±10.44	0.018
Preop CD^‡	0.62±0.22	0.78±0.20	0.026
Postop CD	0.53±0.25	0.79±0.28	0.017
Axial lengths (mm)	24.81±3.17	23.80±3.88	0.564
Corneal diameter (mm)	13.01±0.51	12.76±1.37	0.484

^* Independent t-test

^† IOP=intraocular pressure; CD=Cup to disc ratio.

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