Reversal of optic disc cupping in primary congenital glaucoma: analysis of 1223 eyes

BACKGROUND/AIMS: To determine the prevalence and predictors of postoperative optic disc cupping reversal in primary congenital glaucoma (PCG). METHODS: This retrospective chart review included 1223 eyes of 775 children with primary congenital glaucoma who underwent surgery between 1993 and 2023 and had at least 1 year of follow-up. Baseline demographic and ocular parameters, including age-at-onset, age at surgery, laterality, intraocular pressure (IOP), cup-disc ratio (CDR), axial length (AL) and corneal diameter (CD), were recorded. CDR reversal was defined as a reduction in CDR of at least 0.2 from baseline. For bilateral PCG, both eyes were used for analysis; hence, cluster-robust standard errors were used. Univariable and multivariable logistic regression analyses were performed to identify factors associated with reversal and a scoring system for predicting CDR reversal in PCG eyes was developed from the model. RESULTS: Postoperative cupping reversal was observed in 528 of 1223 eyes (43.2%). On multivariable analysis, a smaller baseline CD and AL remained the strongest predictors of reversal, with every 1 mm increase in CD being associated with a 50% reduction in the odds of postoperative CDR reversal (aOR 0.50, 95% CI 0.42 to 0.59; p<0.001). Neonatal-onset (aOR 2.03, 95% CI 1.04 to 3.93; p=0.036) and infantile-onset disease (aOR 2.45, 95% CI 1.30 to 4.60; p=0.005) were also independently associated with reversal compared with late-onset PCG. CONCLUSIONS: Postoperative CDR reversal occurs in a substantial proportion of PCG eyes and earlier disease onset, smaller CD and shorter AL are strong predictors for reversal.