Evaluation of the factors associated with the reversal of the disc cupping after surgical treatment of childhood glaucoma.

PURPOSE: To evaluate the change in optic disc cupping after surgical procedure for congenital glaucoma and assess the factors that may intervene on this process.

METHODS

Prospective study involving 45 eyes of 36 patients with childhood glaucoma, who underwent surgical treatment at the Hospital Municipal da Piedade, Rio de Janeiro, Brazil, between January 1998 and December 2005. The study included patients <5 years old with intraocular pressure (IOP) <19 mm Hg for at least 6 months after surgery. Children who were > or =5 years old, IOP > or =19 mm Hg after surgery, and cloudy media were excluded from analysis. All patients were submitted a complete examination under narcosis before surgery and 1, 3, and 6 months after surgery. After this period, the follow-up was performed every 6 months until the study finished. To meet study criteria, vertical axis of the cup-to-disc ratio (C/D) was considered. The optic disc cupping was assessed independently before and after surgery by the same clinicians and the stabilization of the optic disc was confirmed in at least 2 consecutive tests. The variables evaluated with the reduction of the C/D were age at the time of the surgery, vertical axis of the optic disc cup, IOP and the horizontal corneal diameter preoperatively, quantity and type of surgical procedures performed, range of IOP reduction, number of antiglaucomatous drops taken postoperatively, and the type of glaucoma. The statistical methods were performed by the BioEstat 3.0 program.

RESULTS

There was a significant difference between the preoperative (0.75+/-0.15) and postoperative (0.62+/-0.22) C/D and the IOP measured preoperative (22.40+/-4.93 mm Hg) and postoperative (12.33+/-3.84 mm Hg). The variables that disclosed statistical significance were age at the time of surgery (P=0.008) and the reduction of the IOP after surgery (P=0.048). A higher reduction of cupping was observed in children < or =1 year old (0.18+/-0.12) at the time of the surgery.

CONCLUSIONS

Optic disc cupping can be reversed at an early stage of primary congenital glaucoma, especially before 1 year of age, after successful reduction of IOP by surgery.