Long-term structural and functional outcomes of therapy in juvenile-onset primary open-angle glaucoma: a five-year...

To evaluate long-term structural and functional changes of the optic nerve head in medically and surgically treated juvenile-onset primary open-angle glaucoma (JOAG).

Forty-two eyes of 42 consecutive primary JOAG patients presenting between January 2000 and January 2003. Results were analysed for long-term intra-ocular pressure (IOP) control, IOP fluctuation, disc characteristics on a Heidelberg Retinal Tomograph II and for visual field changes over a 5-year period. The parameters were compared between medically and surgically treated eyes.

The average age of the patients was 26.8 ± 6.1 years. The average baseline IOP was 35.3 ± 14.9 mm Hg. An IOP control <18 mm Hg was achieved in 84% of eyes that underwent filtering surgery (n = 17), compared to 63% on medical therapy alone (n = 25) at the end of 5 years; log rank test p = 0.38. Over 5 years, 4 eyes showed progression (9.5%) of which 3 had been medically treated and 1 had failed surgery (p = 0.45).

A tenth of JOAG eyes showed progression over 5 years, and this was more common in those treated medically. Aggressive IOP lowering may thus be needed in eyes with JOAG.