Purpose

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).

Design

Retrospective observational case series from an ongoing prospective cohort study.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

---

儿童青光眼视神经乳头杯状逆转后的术中安装光学相干断层扫描结果

目的

检查儿童青光眼婴儿视神经乳头 (ONH) 和黄斑发生的结构变化，以及临床观察到的降低眼压 (IOP) 青光眼手术后 ONH 杯状逆转，通过术中光谱域光学相干断层扫描捕获（SD-OCT）。

设计

来自正在进行的前瞻性队列研究的回顾性观察病例系列。

方法

其中包括 14 名儿童青光眼患者的 18 只眼。所有眼睛在青光眼干预前后都进行了 SD-OCT 成像，并在临床上确定了 ONH 杯状逆转。排除眼压降低后图像质量差或视神经持续肿胀的患者。结果测量包括眼压、杯盘比、轴长和 peripapillary 视网膜神经纤维层 (pRNFL) 的 SD-OCT 测量、布鲁赫膜开口 (BMO-D) 的横向水平直径、杯深度和黄斑。

结果

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 IOP 降低了 45%，同时杯盘比 (0.30±0.12, p<0.001)、眼轴长度 (0.43±0.28mm, p<0.001) 和杯深度 (46%) 显着降低, p<0.001)。治疗前和治疗后的平均全球 pRNFL 厚度分别为 93.1±14.7µm 和 93.1±17.1µm，p=1.0。治疗前和治疗后的整体或局部 pRNFL、3mm 黄斑总和分段视网膜层体积或 BMO-D 没有显着差异。

结论

眼压降低手术后临床 ONH 杯形逆转与眼轴长度减少和杯深度减少相关，但 pRNFL 或黄斑体积测量没有显着变化。ONH 杯突逆转可能标志着稳定，但任何干预前的 ONH 损伤仍然存在。