The distended disc in early stages of congenital glaucoma

In 12 out of 18 eyes operated upon for congenital glaucoma without associated diseases the preoperative glaucomatous cupping had disappeared at follow-up 2 weeks to 3 months after the operation (trabeculotomy ab externo on 9 eyes and trabeculectomy on 3 eyes). Of the 12 eyes, 10 had had the operation performed before the age of 6 months, in contrast to the group in which glaucomatous cupping of the disc was irreversible where operation had been performed in the age range 6 months--12 years (mean 6 years). The mean postoperative tension value in the 18 eyes was 12 mm (range 8-20) mm) without medication, mean observation time 3 years. It seems likely that during the first phases of congenital glaucoma the disc is distended, i.e. of increased diameter and depth. This form of glaucomatous cupping and the increased diameter of the disc may be due to pressure-conditioned enlargement of the scleral canal and omnidirectional distention of the lamina cribrosa. This distention manifests itself mainly in the central areas of the lamina cribrosa and the disc, and usually disappears when the tension is normalized by surgery during the first phases of the disease.