Clouding of cornea portends blindness in kids with infantile glaucoma

Children with primary congenital glaucoma (PCG) are at risk of going blind in the presence of corneal clouding, a study has found.

The study included 196 childhood glaucoma patients aged 9.54 months on average at presentation. A best corrected visual acuity (BCVA) of 3/60 (20/400) or worse in the better eye at final follow-up characterized blindness.

Over a mean follow-up of 8.49 years, 20 children (10.2 percent) developed blindness. Baseline demographic factors, intraocular pressure, horizontal corneal diameter, spherical equivalent, axial length, and corneal thickness did not largely differ between children who went blind and those who had better visual acuity (p>0.05).

On multivariate logistic regression analysis, only the severity of corneal opacification showed a significant association with the risk of blindness (odds ratio, 4.05, 95 percent confidence interval, 1.89–8.85; p<0.001).

The present data suggest that children with severe corneal clouding undergo closer monitoring and receive more aggressive intraocular pressure control and earlier counselling.

Epiphora, photophobia, and blepharospasm are the classical triad of symptoms in congenital glaucoma. However, corneal abnormalities such as corneal enlargement or corneal clouding are the most common signs first recognized by parents or doctors. [BMC Ophthalmol 2018;18:190]

Corneal opacity or clouding potentially leads to stimulus deprivation amblyopia, which has been reported to be one of the major causes of vision loss in children with PCG. [Ophthalmology 2020;122:87-92]