Glaucomatous optic neuropathy in congenital glaucoma

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Abstract

Purpose

Morphometric analysis of posterior pole structures of the eye in children with congenital glaucoma (CG)

Methods

34 children aged 3 months-11 yrs with various forms and stages of CG were examined with HRT-3 and Spectralis HRA+OCT.

Results

We established the early appearance of deep and bulk excavation and reduction of neuroretinal rim area and volume at the beginning of glaucoma manifestation, mean total RNFL thickness reducing, reflecting the degree of the optic nerve structures atrophy. Correlations between changes of the optic disc parameters, glaucoma stages and the eye size were revealed. In all glaucoma eyes we noted thinning of peripapillary RNFL. 89% of children showed a decrease of arteries caliber (8-25% of normal) and veins (23-40% of normal). In 80% of the eyes there was an increase in AVI (ave 0.81).The choroidal topography study showed an increase of the subfoveolar thickness (305-957 μm) in 80% of children. Examination of the macular area revealed OD-OS asymmetry of total macular volume in glaucoma eyes(healthy eyes - 8,50±0.36mm3, glaucoma eyes - 7.51±0,63 mm3,p<0.001).Ganglion cell layer (GCL) thickness in the perifoveolar area in glaucoma eyes was significantly below normal and averaged 34.4±9.65 μm, the thickness of the temporal section was lower than the nasal (34.20±9.53 μm, 39.06±10.60 μm, resp.). GCL is affected earlier than the changes in other layers of macular area.

Conclusion

The distinctive feature of glaucomatous optic neuropathy in CG is a combination of significant structural changes in the optic nerve and retinal layers due to secondary distension of the membranes of the eye, with retinal vessels involved in the process, with some hemodynamic changes in the retina and choroid, all of which worsened with the progression of glaucoma.

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