Optic disc cupping reversed in 43% of eyes after surgery for primary congenital glaucoma

Design

Retrospective chart review, single tertiary centre, 1993 to 2023

Population

1,223 eyes of 775 children with primary congenital glaucoma, at least 1 year of follow-up

Primary outcome

Cup-disc ratio reduction of at least 0.2 after surgery

Effect

43.2% (528 of 1,223 eyes); corneal diameter per 1 mm adjusted OR 0.50 (95% CI 0.42 to 0.59)

This retrospective chart review at an Indian centre included 1,223 eyes of 775 children with primary congenital glaucoma who had surgery between 1993 and 2023 and at least a year of follow-up. Cupping reversal was a cup-to-disc ratio reduction of at least 0.2.

Reversal occurred in 528 eyes (43.2%). Smaller baseline corneal diameter and shorter axial length were the strongest predictors: each 1 mm increase in corneal diameter was linked to halved odds of reversal (adjusted OR 0.50, 95% CI 0.42 to 0.59). Neonatal-onset (aOR 2.03, 95% CI 1.04 to 3.93) and infantile-onset disease (aOR 2.45, 95% CI 1.30 to 4.60) were also linked to reversal compared with late-onset disease.

A reduction in cupping can be reassuring but does not by itself prove that visual function is protected. The authors built a scoring system from the model, which was not validated externally in this report.

• Expect cupping to reduce in a substantial share of children after successful pressure control.
• Do not assume that reversal means safe; keep following pressure, fields where possible and acuity.
• Use baseline corneal diameter and axial length to set parental expectations.
• Refer neonatal and infantile onset cases early, since they were more likely to show reversal.

Why it matters

Cup size is a key follow-up marker, and knowing it can improve helps interpret change over time.

Don't overread it

A retrospective review from one referral centre over 30 years; reversal was not tied to visual outcome.

The statistics, in plain English

An adjusted odds ratio of 0.50 per millimetre of corneal diameter means the odds of reversal halve for each millimetre larger. Both eyes of bilateral cases were analysed, so the authors used cluster-robust errors to allow for correlation.

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