Majumdar Aayush, Panigrahi Arnav, Singh Abhishek, Dada Tanuj, Gupta Viney, Gupta Shikha
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
J AAPOS. 2024 Aug;28(4):103967. doi: 10.1016/j.jaapos.2024.103967. Epub 2024 Jul 4.
To evaluate the incidence of rise in intraocular pressure (IOP) in fellow eyes of patients with unilateral primary congenital glaucoma (PCG) and to identify risk factors for IOP increase over long-term follow-up.
The medical records of unilateral PCG patients who had completed at least 5 years of follow-up were reviewed retrospectively. The incidence of developing ocular hypertension / glaucoma in fellow eyes was analyzed. Fellow eye progressors were those which showed an increase in optic nerve cupping by at least 0.2 since the first presentation or had IOP of >21 mm Hg on two occasions. The risk factors for progression that were analyzed included IOP, visual acuity, axial length, central corneal thickness (CCT), corneal diameters (CD), presence or absence of angle dysgenesis on high-resolution anterior segment optical coherence tomography (AS-OCT), and morphology of aqueous outflow pathways.
After a median follow-up of 8.2 years (range, 5-25.5) progression to bilateral disease was found in 17 of 54 patients (32%), of whom 8 (15%) developed ocular hypertension and 9 (17%) developed glaucoma in the fellow eye. Among the unaffected fellow eyes, those with a larger CD (>12 mm), measured after at least 5 years' follow-up, were ten times more likely to progress (P = 0.01; OR = 9.5 [95% CI, 1.7-54.3]). The presence of a patent supraciliary channel was significantly more frequently associated in fellow eyes compared with affected eyes on AS-OCT (OR = 1.4 [95% CI, 0.46-4.68]).
One-third of unaffected fellow eyes of unilateral PCG eventually progress over time, most often after 5 years. Larger CD at follow-up in the fellow eye is strongly predictive for progression.
评估单侧原发性先天性青光眼（PCG）患者对侧眼眼压升高的发生率，并确定长期随访中眼压升高的危险因素。
回顾性分析至少完成5年随访的单侧PCG患者的病历。分析对侧眼发生高眼压症/青光眼的发生率。对侧眼进展者是指自首次就诊以来视神经杯盘比至少增加0.2或眼压两次大于21 mmHg的患者。分析的进展危险因素包括眼压、视力、眼轴长度、中央角膜厚度（CCT）、角膜直径（CD）、高分辨率眼前节光学相干断层扫描（AS-OCT）上角膜发育异常的有无以及房水流出途径的形态。
中位随访8.2年（范围5 - 25.5年）后，54例患者中有17例（32%）进展为双侧疾病，其中8例（15%）对侧眼发生高眼压症，9例（17%）对侧眼发生青光眼。在未受影响的对侧眼中，至少随访5年后测量的角膜直径较大（>12 mm）的患者进展的可能性是其他患者的10倍（P = 0.01；OR = 9.5 [95% CI，1.7 - 54.3]）。与AS-OCT上受影响的眼睛相比，对侧眼中存在通畅的睫状体上腔的情况明显更常见（OR = 1.4 [95% CI，0.46 - 4.68]）。
单侧PCG未受影响的对侧眼中，三分之一最终会随着时间推移进展，最常见于5年后。随访时对侧眼角膜直径较大强烈预示会进展。
