Evaluating target intraocular pressures in primary congenital glaucoma

Area of Science:

• Ophthalmology
• Pediatric Surgery
• Glaucoma Research

Background:

• Primary congenital glaucoma (PCG) is a severe form of glaucoma present at birth.
• Effective long-term management is crucial to prevent irreversible vision loss.

Purpose of the Study:

• To determine the target intraocular pressure (IOP) for stabilizing or reversing glaucomatous neuropathy after surgery in PCG patients.
• To evaluate the long-term impact of IOP on visual field progression and refractive error.

Main Methods:

• Prospective evaluation of 174 eyes from 108 children with PCG undergoing trabeculectomy-trabeculotomy.
• Follow-up for at least 2 years, monitoring IOP, fundus appearance, refraction, and corneal diameter.
• Statistical analysis, including linear regression, to correlate IOP with cup-to-disc ratio and refractive error.

Main Results:

• Postoperative IOP averaged 11.8 ± 4.5 mm Hg.
• A review IOP range of 6-12 mm Hg showed reversal of glaucomatous neuropathy in 67.9% of eyes.
• Lower IOP (≤15 mm Hg) correlated with reduced myopia progression; surgery before 6 months yielded smaller final cup-to-disc ratios.

Conclusions:

• Postoperative IOP ≤15 mm Hg is associated with stabilization or reversal of glaucomatous neuropathy in PCG.
• Early surgical intervention (before 6 months) improves long-term visual outcomes and reduces myopia.
• Long-term IOP control is critical for preventing further optic nerve damage and associated complications.