Assessment of the anterior segment of patients with primary congenital glaucoma using handheld optical coherence tomography

Abstract

Purpose To investigate the potential of handheld optical coherence tomography (HH-OCT) in assessing the anterior segment of the eye in patients with primary congenital glaucoma. Design A prospective, case-controlled observational study. Participants Twenty-two patients with primary congenital glaucoma (PCG, 9 females and 13 males; mean age 4.36 ± 3.4 years) and age-, gender-and ethnicity-matched healthy participants. Methods Anterior OCT was performed in all participants using a high-resolution HH SD-OCT device (Envisu 2300, Leica Microsystems, Germany) without anaesthesia or sedation. Results Anterior HH-OCT in PCG visualised Haab's striae in 14.3%, uneven internal cornea in 9.5% and epithelial thickening in 11.9% of patients with central corneal thickening (CCT, p < 0.001). CCT was significantly correlated with the intraocular pressure (IOP, p < 0.001). The flat iris with a thin collarette zone was found in 59.5%, anterior iris insertion in 11.90% of eyes affected by PCG. Two independent examiners showed sensitivity and specificity of 87% and 77%, respectively, by instating iris thinning and flattening of the anterior profile. Conclusions Anterior HH-OCT has significant potential to improve diagnosis and management of PCG. Clinically relevant information can be obtained non-invasively and without sedation. High specificity makes anterior HH-OCT an important adjunct for management of PCG. Excellent visualisation of the iris insertion on OCT indicates potential for AS OCT to assist with surgical planning, including decision on the type of surgery and location of the incision.

Feasibility and Repeatability of Handheld Optical Coherence Tomography in Children With Craniosynostosis

“…Handheld OCT has been utilized to describe the normal development of the optic nerve 14 and fovea 15 in children, with excellent feasibility. Furthermore, handheld OCT has been utilized in numerous pediatric conditions, 16 including primary congenital glaucoma, 17 nystagmus, 18 foveal hypoplasia, 19,20 optic nerve hypoplasia, 21 achromatopsia, 22 retinopathy of prematurity, 23 and craniopagus twins, 24 among others. Other OCT devices have demonstrated potential for detecting papilledema and IH in craniosynostosis, but handheld OCT has not yet been used in this patient population.…”

Detection of intracranial hypertension in children using optical coherence tomography: a systematic review

“…Of note, handheld OCT has been recently used to describe the normal development of the optic nerve 27 and fovea 15 16 in infants and children, with excellent feasibility. Handheld OCT has also been utilised in a wide range of other pedatric conditions including retinopathy of prematurity, 56 nystagmus, 57 albinism, 58 achromatopsia, 59 foveal hypoplasia, 60 optic nerve hypoplasia, 61 primary congenital glaucoma, 62 microcephaly 63 and others. Handheld OCT may be better tolerated in young children, particularly those with craniosynostosis associated with cognitive delay.…”

Updates on the molecular genetics of primary congenital glaucoma (Review)

“…The accumulation of aqueous humor leads to disruption in corneal endothelial integrity ( 17 ). A markedly thinned iris with reduced iris folds due to reduced stromal thickness and a severe flattening of the anterior limiting layer with a significant positive correlation with increased intraocular pressure (IOP) were reported in patients with PCG ( 18 , 19 ).…”