Analysis of Visual Outcomes in Children with Primary Congenital Glaucoma

Abstract

Objective: To evaluate the visual outcomes in children with primary congenital glaucoma (PCG) whose intraocular pressure (IOP) was controlled after surgery and to analyze the risk factors for vision loss. Methods: This was a retrospective case series that included 45 PCG patients (72 eyes) with an IOP≤21 mmHg following glaucoma surgery from June 2017 to February 2018 at Zhongshan Ophthalmic Center. The following information was collected from medical records: Sex, laterality, age at presentation and at initial glaucoma surgery, age at last visit, preoperative IOP, corneal diameter, axial length, type of initial glaucoma surgery, number of surgeries, antiglaucoma medication before initial surgery and at the last visit, best corrected visual acuity (BCVA), cup-disc ratio and retinal nerve fiber layer thicknessat the last visit, and ocular comorbidity. The BCVAs at the last follow-up were categorized into 3 groups: Good (≥0.4), moderate (0.3-0.1) or poor (<0.1). Onivariate and multivariate analyses were performed to determine the risk factors for visual imparirment (BCVA≤0.3). Results: At the last follow-up, the mean logMAR BCVA was 0.61±0.60. A good BCVA was attained in 54%, moderate in 35% and poor in 11%. The mean spherical equivalent of refraction was -4.07±4.94 D; myopia was the predominant refractive error (50%). The most common ocular comorbidity was corneal opacity (36%). Age at presentation, medication before initial surgery, age at initial glaucoma surgery, number of surgeries and corneal opacity were associated with vision impairment (P<0.1). Multivariate logistic regression analysis showed that multiple surgeries (≥2) (OR=6.252, 95%CI: 1.174-33.285, P=0.032) were associated with BCVA loss. Conclusion: Good BCVA is attainable in about 50% of affected eyes. Multiple surgeries are the main risk factor of vision impairment. Early diagnosis, prompt, effective treatment, and timely management of ocular comorbidities and correction of refractive error safter surgery may reduce the rate of severe visual impairment. Key words: low vision; primary congenital glaucoma; visual acuity; intraocular pressure; surgery