Utilization of anterior segment optical coherence tomography in childhood glaucoma: A systematic review

We review the current evidence on the use of anterior segment optical coherence tomography (AS-OCT), including handheld systems (HH-AS-OCT), in the diagnosis, monitoring, and surgical evaluation of childhood glaucoma. We conducted a systematic review through PubMed, EBSCO, Web of Science, and Google Scholar. Studies were eligible if they reported original data on AS-OCT in childhood glaucoma patients aged ≤ 18 years. Fifteen studies met the inclusion criteria, encompassing 406 glaucomatous eyes with diverse etiologies such as primary congenital, juvenile open-angle, post-cataract, and syndromic glaucoma. AS-OCT enabled high-resolution visualization of the trabecular meshwork, Schlemm canal, iris, and anterior chamber angle. Several studies proposed diagnostic thresholds for iris thickness and angle width, with area under the receiver operating characteristic curves ranging from 0.69 to 0.87. Postoperative imaging documented drainage device position and angle anatomy, while HH-AS-OCT facilitated imaging in infants and uncooperative children, revealing subclinical abnormalities undetectable by gonioscopy; however, these structural findings do not consistently predict clinical outcomes. Heterogeneity in devices, imaging protocols, and glaucoma phenotypes limits standardization, and no definitive AS-OCT biomarker has yet emerged in childhood glaucoma. Larger longitudinal studies and pediatric normative databases are needed before AS-OCT can be regarded as more than an adjunctive imaging modality in this setting.