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Detection and characterisation of optic nerve and retinal changes in primary congenital glaucoma using hand-held optical coherence tomography

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journal contribution
posted on 2020-05-14, 11:06 authored by AV Pilat, S Shah, V Sheth, R Purohit, FA Proudlock, J Abbott, I Gottlob
Objective To investigate (1) the feasibility of scanning the optic nerve (ON) and central retina with hand-held optical coherence tomography (HH-OCT) without sedation or anaesthesia in primary congenital glaucoma (PCG), (2) the characteristics of ON changes in comparison with adult primary open-angle glaucoma (POAG) in comparison with matched controls, (3) the sensitivity and specificity of ON parameters for diagnosis, and (4) changes of foveal morphology. Methods and analysis HH-OCT (Envisu 2300; Leica Microsystems) was used to investigate ON and foveal morphology of 20 children with PCG (mean age 4.64±2.79) and 10 adult patients with POAG (mean age 66.8±6.94), and compared with age-matched, gender-matched and ethnicity-matched healthy controls without sedation or anaesthesia. Results HH-OCT yielded useful data in 20 out of 24 young children with PCG. Patients with PCG had significantly deeper cup changes than patients with POAG (vs respective age-matched controls, p=0.014). ON changes in PCG are characterised by significant increase in cup depth (165%), increased cup diameter (159%) and reduction in rim area (36.4%) as compared with controls with high sensitivity (81.5, 74.1% and 88.9%, respectively) and specificity (85.0, 80.0% and 75.0%, respectively). Patients with PCG have a significantly smaller width of the macula pit (p<0.001) with non-detectable external limiting membrane. Conclusion HH-OCT has the potential to be a useful tool in glaucoma management for young children. We have demonstrated the use of HH-OCT in confirming a diagnosis of glaucoma within the studied cohort and found changes in disc morphology which characterise differently in PCG from POAG.

Funding

Supported by a Medical Research Council Grant (MR/J004189/1 and MR/ N004566/1) and the Ulverscroft Foundation.

History

Citation

BMJ Open Ophthalmology 2019;4:e000194

Author affiliation

Ophthalmology Group

Version

  • VoR (Version of Record)

Published in

BMJ Open Ophthalmology

Volume

4

Issue

1

Pagination

e000194

Publisher

BMJ Publishing Group

eissn

2397-3269

Acceptance date

2019-05-12

Copyright date

2019

Publisher version

https://bmjophth.bmj.com/content/4/1/e000194

Language

eng

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