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Luisa Vieira1; Mariana Sá Cardoso2; Rita Anjos3; Cristina Ferreira3; Ana Xavier3; Vítor Maduro3; Cristina Brito3

1- Hospital Divino Espirito Santo de Ponta Delgada;
2- Serviço de Oftalmologia, Centro Hospitalar do Baixo Vouga
3- Unidade de Oftalmologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa

- 56º Congresso Sociedade Portuguesa de Oftalmologia, Vilamoura, dezembro 2013, Vilamoura, dezembro 2013 (Prémio Placido 2013– melhor trabalho do Congresso)
- Association for Research in Vision and Ophthalmology (ARVO 2014), Orlando, maio 2014
- 40th Annual Meeting of the European Pediatric Ophthalmological Society (EPOS), Barcelona, novembro 2014
- Publicado em  Oftalmologia, Revista da Sociedade Portuguesa de Oftalmologia - Vol. 38: pp.165-174

Introduction: Primary congenital glaucoma (PCG), caracterized by an iridocorneal angle development anomaly, is a relatively rare disease but an important cause of blindness. Anterior segment optical coherence tomography (AS-OCT) is a high resolution and non-contact method of anterior segment evaluation. Its interest has been growing, mainly in adults. Anterior segment evaluation in children is challenging and till recently only done by ultrasond biomicroscopy. In 2012, Cauduro et al suggested AS-OCT as valid in many pediatric pathologies. The purpose of our study was to analyse anterior segment structure using (AS-OCT) in children with PCG.
Methods: A prospective case-control study was conducted in children with PCG and without glaucoma (control group), followed in Pediatric Ophthalmology Section of Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central. A complete ophthalmologic evaluation and AS-OCT (AC biometry protocol) were done.
Results: Twenty-seven eyes (17 children with PCG) and 22 eyes (11 healthy children) were enrolled in this study. In PCG group were detected higher values of anterior chamber (AC) width and central depth (p<0,001), larger angle-opening distance at 500 (p<0,001) and 750μm (p=0,001), trabecular-iris space area at 500 and 750μm (p<0,001) and angle recess area at 500 (p<0,001) and 750μm (p=0,001). Iris was significantly thinner at 500μm from the scleral spur (p=0,011), in the middle of the iris (p<0,001) and at the thickest part (p=0,001), and longer (p<0,001), in PCG group. Visual acuity (logMAR) and AC width were positively correlated (r=0,688; p<0,001). To each millimeter of AC width increase, the risk to achieve low vision increases 7 times. Other features found were: iris hypoplasia and anterior displacement, morphologic changes at the angle related to the surgical intervention site (goniotomy, trabeculotomy, trabeculectomy, Ahmed valve).
Conclusion: This first study in children with PCG suggests that AS-OCT is relatively easy to acquire, can help in clinical and surgical follow-up and be useful as prognostic factor.

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