Optic Disc Evaluation

Glaucomatous optic disc cupping is seen in the majority of children with infantile glaucoma, as far as limited corneal clarity allows visualization of the optic disc. The degree of optic disc excavation depends on the size of the optic disc, the pressure level, and the duration of increased intraocular pressure.

A reversal of optic disc cupping after pressure-reducing surgery can be observed at an early stage of primary congenital glaucoma. This phenomenon of an "improved" cup disc ratio occurs if intraocular pressure is successfully reduced, especially during the 1st year of life. Between the 2nd and 5thyears of life, unchanged cupping is more frequent following successful glaucoma surgery [57]. In older children, optic disc cupping is considered to be the safest parameter to indicate the stage of glaucomatous damage.

Little information is available on the clinical potential of optic disc morphometry by laser scanning tomography in children with congenital glaucoma. Compliance in children of 4 or 5 years is often already sufficiently good to perform laser scanning tomography of the optic

Fig. 7.2. Macroexcavation in a large optic disc (>4 mm2). This healthy 6-year-old boy was suspected of having childhood glaucoma. Follow-up revealed no change of the macroexcavation

disc and this is extremely helpful to rule out or to clearly quantify a macroexcavation in a very large optic disc (Fig. 7.2) and to avoid unnecessary treatment.

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