title: Cupping reversal in pediatric glaucoma--evaluation of the retinal nerve fiber layer and visual field.
abstract: OBJECTIVE
  To identify optic nerve head (ONH) cupping reversal and associated optical coherence tomography (OCT) and Humphrey visual field changes in pediatric glaucoma.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  Sequential surgical cases of juvenile open-angle glaucoma (OAG) or primary congenital glaucoma (PCG) with sustained postoperative intraocular pressure (IOP) reduction. Group 1 had preoperative and postoperative ONH photographs and OCT; Group 2 had preoperative clinical ONH assessment and postoperative imaging. Cupping evaluation was confirmed by masked glaucoma and neuro-ophthalmology specialists.
  
  
  RESULTS
  Of 80 cases, 9 eyes (9 children) met criteria for Group 1; 24 eyes (19 children) met criteria for Group 2. Group 1: Five of 9 eyes (56%) demonstrated cupping reversal, with preoperative vs postoperative mean IOP 34.2 ± 6.6 mm Hg vs 10.6 ± 4.1 mm Hg (P < .00001) and mean average retinal nerve fiber layer (RNFL) 71.0 ± 30 μm vs 62.8 ± 24 μm (P = .4), respectively. RNFL was stable in 4 of 5 eyes (all juvenile OAG), but thinned (Δ = -41 μm) in 1 eye with PCG. Humphrey visual fields (reliable in 2 of 3 eyes) showed no significant change. Group 2: Fourteen of 24 PCG eyes (58%) demonstrated cupping reversal, with preoperative vs postoperative mean IOP 36.1 ± 8.9 mm Hg vs 13.3 ± 2.1 mm Hg (P < .00001). Two eyes had thin RNFL postoperatively despite healthy-appearing ONH. Postoperative RNFL showed statistically significant linear correlation with preoperative (but not postoperative) cup-to-disc ratio. Limitations include small numbers, few reliable Humphrey visual fields, and absent preoperative imaging (Group 2).
  
  
  CONCLUSIONS
  Some eyes with IOP reduction and ONH cupping reversal show continued RNFL thinning postoperatively. The preoperative ONH cup-to-disc ratio predicted the postoperative RNFL better than the postoperative "reversed and smaller" cup-to-disc ratio. Cupping reversal in pediatric glaucoma may not predict improved ONH health and deserves further study.
authors: Duke Eye Center, Durham, North Carolina.
authors: Amanda L
authors: AL
authors: Ely
authors: Duke Eye Center, Durham, North Carolina.
authors: Mays A
authors: MA
authors: El-Dairi
authors: Duke Eye Center, Durham, North Carolina. Electronic address: Sharon.freedman@duke.edu.
authors: Sharon F
authors: SF
authors: Freedman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure; D008297:Male; D009412:Nerve Fibers / Q000473:pathology*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D020127:Recovery of Function; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D014794:Visual Fields / Q000502:physiology*