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Ophthalmic Images
April 9, 2020

Reversal of Cupping in an Infant, Shown by Optical Coherence Tomography

Author Affiliations
  • 1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
JAMA Ophthalmol. 2020;138(4):e191448. doi:10.1001/jamaophthalmol.2019.1448

A 10-month-old white male infant with primary congenital glaucoma underwent successful goniotomy in the right eye, lowering intraocular pressure from 34 mm Hg to 11 mm Hg and decreasing axial length from 23.4 mm to 22.8 mm. We used optical coherence tomography (HRA+OCT Spectralis with Flex module [Heidelberg Engineering]) to image the optic nerve preoperatively and at 1 month postoperatively. The cup-disc ratio decreased from 0.6 to 0.4. The reversal of cupping was associated with decreased cup depth and an anterior shift of the Bruch membrane on optical coherence tomography (Figure). Notably, the preoperative and postoperative Bruch membrane opening size and peripapillary retinal nerve fiber (100 μm vs 96 μm; image not shown) were not significantly changed. This is consistent with prior reports that scleral response to elevated intraocular pressure will be gradual and mostly nonreversible and cupping reversal is associated with changes in prelaminar tissue.1,2 This case demonstrates these changes in an infant via optical coherence tomography.

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