From the Department of Ophthalmology (T.S.G., M.P.K., M.A.D., S.F.F.), Duke University Medical Center, Durham, North Carolina, USA.
Department of Ophthalmology (M.S.G.), University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.
Am J Ophthalmol. 2022 Nov;243:109-117. doi: 10.1016/j.ajo.2022.08.003. Epub 2022 Aug 8.
To examine the structural changes occurring in the optic nerve head (ONH) and macula in infants with childhood glaucoma and clinically observed ONH cupping reversal following intraocular pressure (IOP)-reducing glaucoma surgery, as captured by intra-operative spectral-domain optical coherence tomography (SD-OCT).
Retrospective observational case series from an ongoing prospective cohort study.
Included were 18 eyes of 14 patients with childhood glaucoma. All eyes had SD-OCT imaging pre- and post-glaucoma intervention and clinically identified ONH cupping reversal. Patients with poor quality images or persistent optic nerve swelling following IOP reduction were excluded. Outcome measurements included IOP, cup-to-disc ratio, axial length and SD-OCT measurements of the peripapillary retinal nerve fiber layer (pRNFL), transverse horizontal diameter of Bruch membrane opening (BMO-D), cup depth, and macula.
Mean age at surgery was 1.14±0.93 years and mean interval between pre- and post-operative imaging was 127 days (range 35-595). Following intervention, mean IOP reduction was 45%, accompanied by significant reductions in the cup-to-disc ratio (0.30±0.12, p<0.001), axial length (0.43±0.28mm, p<0.001) and cup depth (46%, p<0.001). Mean global pRNFL thickness pre- vs. post-treatment was 93.1±14.7µm vs. 93.1±17.1µm, respectively, p=1.0. There was no significant difference in pre- and post-treatment global or sectoral pRNFL, 3mm macular total and segmented retinal layer volumes, or the BMO-D.
Clinical ONH cupping reversal after IOP-lowering surgery was associated with axial length reduction and decrease in cup depth, but no significant change in the pRNFL or macular volume measures. ONH cupping reversal likely marks stabilization but any pre-intervention ONH damage persists.
通过术中频域光相干断层扫描（SD-OCT）检查儿童青光眼患者视神经头（ONH）和黄斑的结构变化，并观察眼压（IOP）降低性青光眼手术后临床观察到的 ONH 杯状逆转。
一项正在进行的前瞻性队列研究中的回顾性观察性病例系列。
纳入了 14 名患有儿童青光眼的患者的 18 只眼。所有患者均在青光眼干预前后进行了 SD-OCT 成像，且临床发现 ONH 杯状逆转。排除了图像质量差或 IOP 降低后视神经肿胀持续存在的患者。测量的结果包括眼压、杯盘比、眼轴长度和 SD-OCT 测量的视盘周围视网膜神经纤维层（pRNFL）、Bruch 膜开口横径（BMO-D）、杯深和黄斑。
手术时的平均年龄为 1.14±0.93 岁，术前和术后成像之间的平均间隔为 127 天（范围 35-595）。干预后，平均眼压降低 45%，杯盘比（0.30±0.12，p<0.001）、眼轴长度（0.43±0.28mm，p<0.001）和杯深度（46%，p<0.001）均显著降低。治疗前与治疗后的平均全球 pRNFL 厚度分别为 93.1±14.7µm 和 93.1±17.1µm，p=1.0。治疗前后的全球或扇形 pRNFL、3mm 黄斑总视网膜层和分段视网膜层体积或 BMO-D 无显著差异。
IOP 降低手术后临床观察到的 ONH 杯状逆转与眼轴长度缩短和杯深度减小有关，但 pRNFL 或黄斑体积测量无显著变化。ONH 杯状逆转可能标志着稳定，但任何术前 ONH 损伤仍然存在。
