The pathological increase of the axial length leading to the typical buphthalmic configuration of the eye is an extremely frequent sign in congenital glaucoma during the 1st years of life. Beyond the 4th year of life, the onset of glaucoma is usually not associated with buphthalmic growth of the eye owing to age-dependent changes in the sclera architecture. In contrast to tonometry, which offers only a snapshot of intraocular pressure fluctuations, the pathologically increased axial length in congenital glaucoma reflects the long-term level of intraocular pressure.

Preoperative axial length and age are basic factors in the interpretation of ocular growth following glaucoma surgery in primary congenital glaucoma. Temporary cessation of ocular growth is a frequent finding after successful pressure-reducing surgery in eyes with an axial length greater than 22 mm and in children aged 3 months or older.

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