Design: Retrospective single-centre chart review, 30 years
Population: 1,223 eyes of 775 children operated for primary congenital glaucoma
Primary outcome: Cup–disc ratio reduction ≥0.2 after surgery
Effect: Reversal in 43.2%; corneal diameter aOR 0.50 (0.42 to 0.59) per mm

This retrospective review, published 15 September in the British Journal of Ophthalmology, analysed 1,223 eyes of 775 children who had surgery for primary congenital glaucoma between 1993 and 2023, with at least a year of follow-up. Reversal was defined as a fall in cup–disc ratio of at least 0.2.

Cupping reversed in 528 eyes (43.2%). A smaller baseline corneal diameter and shorter axial length were the strongest predictors: each 1 mm larger cornea halved the odds of reversal (aOR 0.50, 95% CI 0.42 to 0.59). Neonatal-onset (aOR 2.03) and infantile-onset disease (aOR 2.45) were more likely to reverse than late-onset disease. The authors developed a scoring system from the model.

Cupping reversal is a sign that pressure control has been achieved while the infant eye is still elastic. Its absence, particularly in eyes with small corneas that would be expected to reverse, is a prompt to check whether pressure is truly controlled.

Expect disc cupping to reverse in about four in ten eyes after successful congenital glaucoma surgery.
Reversal is more likely with earlier onset, smaller corneas and shorter axial length.
Use cup–disc ratio change as one marker of postoperative pressure control in infants.
Investigate further if cupping fails to improve in an eye expected to reverse.

Why it matters

Gives surgeons a structural sign to judge success in children who cannot do visual fields.

The statistics, in plain English

An adjusted odds ratio of 0.50 per millimetre of corneal diameter means each extra millimetre halves the odds of reversal, after accounting for the other factors.