Corneal clouding may predict blindness in primary congenital glaucoma
Baseline features associated with blindness in children with primary congenital glaucoma showed that corneal clouding can predict future blindness, according to research published in the American Journal of Ophthalmology.
Moreover, the data indicated severe corneal clouding should be monitored via close follow-ups and earlier counselling.
“A number of factors contribute to corneal clouding in children with primary congenital glaucoma (PCG),” Rayan Alshigari, MD, of King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, and colleagues wrote. “PCG itself can result in clouding of the cornea, which usually can be reduced by pharmacologic or surgical reduction of IOP.”
Alshigari and colleagues conducted a retrospective clinical cohort study, enrolling 196 children with glaucoma diagnoses to compare baseline characteristics at initial presentation of children who were blind at the last follow-up and those who were not defined as blind. Researchers defined blindness using WHO criteria: best corrected visual acuity of no better than 3/60 in the better eye. Blindness in at least one eye was defined as BCVA of no better than 3/60 in the worse eye.
The researchers sought to determine the baseline risk factors associated with eventual blindness in children with PCG. They reported potential risk factors could enable early diagnosis of blindness.
After a mean follow-up of 8.49 years, 10.2% of the children were blind, and 25.5% were blind in at least one eye.
Analysis of baseline characteristics concluded that IOP, spherical equivalent, axial length, corneal thickness and corneal diameter were consistent among blind and not blind groups.
According to the data, nearly two-thirds of eyes defined as blind had grade 3 corneal clouding. Investigators reported that only severe corneal opacifications remained associated with a potential risk of blindness (OR = 4.05; 95% CI, 1.89-8.85) after multivariate regression.
“A related limitation is that we did not perform a detailed assessment of corneal grading at each visit after the baseline. As such, our study cannot give conclusions regarding children who had improvements in corneal clouding but who still ended with blindness” Alshigari and colleagues wrote.
Perspective
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PCG is the most common type of childhood glaucoma and is typically diagnosed at birth or in the first year of life. A significant concern for these patients, as with all children, is the long-term visual prognosis. Previous studies have suggested that unilateral disease, multiple surgeries, poor vision at diagnosis and ocular comorbidities are likely indicators for poor visual outcomes for those with PCG.
Through a retrospective cohort study, Alshigari and colleagues aimed to further examine risk factors for PCG-related blindness. They noted the significance of corneal clouding and its long-term effect on visual acuity, finding that blind children tended to have more severe and diffuse corneal clouding.
While most of us don’t see many of these cases, I find that my most important role sometimes goes beyond diagnosing and managing ocular disease. Knowing this potential association allows us to make recommendations to the families of these children to help them thrive. We can be the resource they need, guiding them toward vision therapy, psychological counseling or low vision resources based on the early identification of children at high risk for blindness or vision impairment.
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