Glaucoma surgery in children with primary congenital or juvenile open-angle glaucoma shows persistent vessel narrowing and cup reversalStudy tracks eye blood vessel changes after glaucoma surgery in children

PurposeTo investigate postoperative changes in peripapillary retinal vessel caliber and optic disc structure in childhood glaucoma.DesignProspective, comparative cohort study with a 2-year follow-up.MethodsThis study included 24 glaucomatous eyes (primary congenital or juvenile open-angle glaucoma) and 24 age-matched normal control eyes. Quantitative parameters, including vessel diameters (standardized to the vertical disc diameter), cup-to-disc ratios (CDR), rim widths, and β-zone parapapillary atrophy (PPA) morphology, were measured from standardized optic disc-centered fundus photographs using image analysis software (ImageJ).ResultsPreoperatively, glaucomatous eyes demonstrated attenuated peripapillary vessel diameters, with the superior temporal vessels being significantly narrower than those in controls (P < 0.05). Postoperatively, despite successful IOP reduction (32.11 ± 8.36 to 14.30 ± 2.55 mmHg, P < 0.001), a paradoxical further narrowing of major peripapillary veins and arteries were observed which remained abnormally narrow compared to controls (P < 0.001). Although the mean vertical CDR change was not significant, 16.67% (4/24) of patients exhibited notable cup reversal. This reversal was strongly correlated with inferior rim widening (R2 = 0.84, P < 0.001). Preoperative disc hemorrhage and a higher β-zone PPA Regularity Index were independent predictors of cup reversal.ConclusionSuccessful surgery unmasks a dichotomous remodeling response: a limited, biomechanical optic cup reversal in a subset of patients, linked to rim widening and an increase in PPA regularity, coexists with a persistent and paradoxical narrowing of the large retinal vessels. This indicates that vascular alterations may constitute a maladaptive or irreversible component of glaucomatous damage in children, distinct from the partially reversible connective tissue changes.