Reversal of optic disc cupping in primary congenital glaucoma: analysis of 1223 eyes

To determine the prevalence and predictors of postoperative optic disc cupping reversal in primary congenital glaucoma (PCG).

This retrospective chart review included 1223 eyes of 775 children with primary congenital glaucoma who underwent surgery between 1993 and 2023 and had at least 1 year of follow-up. Baseline demographic and ocular parameters, including age-at-onset, age at surgery, laterality, intraocular pressure (IOP), cup-disc ratio (CDR), axial length (AL) and corneal diameter (CD), were recorded. CDR reversal was defined as a reduction in CDR of at least 0.2 from baseline. For bilateral PCG, both eyes were used for analysis; hence, cluster-robust standard errors were used. Univariable and multivariable logistic regression analyses were performed to identify factors associated with reversal and a scoring system for predicting CDR reversal in PCG eyes was developed from the model.

Postoperative cupping reversal was observed in 528 of 1223 eyes (43.2%). On multivariable analysis, a smaller baseline CD and AL remained the strongest predictors of reversal, with every 1 mm increase in CD being associated with a 50% reduction in the odds of postoperative CDR reversal (aOR 0.50, 95% CI 0.42 to 0.59; p<0.001). Neonatal-onset (aOR 2.03, 95% CI 1.04 to 3.93; p=0.036) and infantile-onset disease (aOR 2.45, 95% CI 1.30 to 4.60; p=0.005) were also independently associated with reversal compared with late-onset PCG.

Postoperative CDR reversal occurs in a substantial proportion of PCG eyes and earlier disease onset, smaller CD and shorter AL are strong predictors for reversal.