Corneal Configurations and High-order Aberrations in Primary Congenital Glaucoma

Corneal changes are prevalent in eyes with primary congenital glaucoma (PCG). This study aimed to describe corneal irregularity and high-order aberrations (HOAs) in PCG eyes.

The study consecutively enrolled 61 PCG eyes (of 39 participants with PCG) and 61 age-matched control eyes (of 61 healthy participants). Participants underwent corneal topography, best spectacle-corrected visual acuity (BSCVA), and fundus photography. Corneal irregularity and HOAs were derived from topographic data and evaluated over central 4 and 6 mm diameter zones. Variables were compared between PCG and control eyes. Percentages of PCG eyes with abnormal corneal irregularity and HOAs were calculated.

The median ages of PCG and control participants were 8.8 and 8.6 years, respectively. Irregularity and total HOAs across both 4 and 6 mm zones were greater in PCG than in control eyes. The median irregularity of PCG eyes was 2 to 5 times that of the controls, whereas, their median total HOAs were approximately twice those of the controls. Thirty-nine (64%), 53 (87%), and 40 (66%) PCG eyes had abnormal (either 4 or 6 mm zone) anterior irregularity, posterior irregularity, and total HOAs. Similar percentages were observed among eyes with a cup-to-disc ratio <0.6 (n=28). Among 13 eyes with cup-to-disc ratio <0.6 but abnormal 4 mm total corneal HOAs, 9 (69%) had BSCVA<20/25, whereas only 1 of 7 (14%) had BSCVA<20/25 among eyes with normal HOAs.

Abnormal corneal irregularity and HOAs are common in PCG eyes, even in those with limited optic nerve damage. These abnormalities relate to compromised visual outcomes.