Assessment of diagnostic criteria in management of infantile glaucoma. An analysis of tonometry, optic disc cup, corneal diameter and axial length.

BACKGROUND

Infantile glaucoma is characterized by increased intraocular pressure, enlarged corneal diameters, optic disc cupping and typical anamnesis. The aim of our study was to evaluate the validity of diagnostic criteria in differentiating between manifest infantile glaucoma and glaucoma-suspected eyes (e.g. megalocornea).

METHODS

We retrospectively analyzed consecutive charts of 87 children undergoing ophthalmic examination under general anesthesia because of manifest or suspected glaucoma. At first examination in our clinic age-related differences of diagnostic parameters between 52 children with infantile glaucoma requiring glaucoma-surgery (group A) and 35 glaucoma-suspect children requiring no surgery (group B) were assessed using non-parametric Mann-Whitney U Test. Influence of tonometry, optic disc cupping, and changes of axial length and corneal diameter during the follow-up on our decision for surgery were also investigated.

RESULTS

Tonometry, axial length of the eye, optic disc cupping, incidence of corneal opacities and age of onset of symptoms were significantly different in the two groups (p < or = 0.002) from first through third year of life, whereas corneal diameters were not significantly different in the second and third year of life. Advanced disc excavation (C/D > 0.6) and increased IOP (> 16 mmHg) were significantly associated with the decision to undertake subsequent surgery (p < 0.0001). Changes of corneal diameter and axial length during follow-up showed no significant difference between those glaucoma patients who needed re-operation and those who did not, after the first year of life.

CONCLUSION

Corneal diameters and axial length were helpful in the diagnosis of infantile glaucoma, but of limited use in the follow-up. The decision to undertake surgery was based upon tonometry and optic disc evaluation.