In Vivo Analysis of Angle Dysgenesis in Primary Congenital, Juvenile, and Adult-Onset Open Angle Glaucoma

The purpose of this study was to comparatively evaluate angle dysgenesis in vivo, among congenital, juvenile, and adult-onset open angle glaucoma patients. A cross-sectional evaluation of 96 glaucoma patients, 22 children with primary congenital glaucoma (PCG) old enough to cooperate for optical coherence tomography (OCT), 34 juvenile-onset open angle glaucoma (JOAG) patients, 40 adult-onset primary open angle glaucoma (POAG), and 30 healthy subjects, was carried out using high-resolution anterior segment spectral domain (SD)-OCT. Subgroup analysis was done for presence/ absence of angle dysgenesis as defined by presence of abnormal tissue/hyperreflective membrane within angle recess and/or absence of Schlemm's canal (SC). Morphologic features suggestive of angle dysgenesis such as the presence of abnormal tissue at the angle and a hyperreflective membranous structure covering the meshwork were seen in all PCG eyes (100%), in 14 (40%) JOAG eyes, and none of the POAG eyes in comparison to healthy eyes (P = 0.01, P = 0.03, and P = 0.23 for PCG, JOAG, and POAG, respectively). SC could be seen in 27 (90%) healthy eyes compared with only 7 (30%) in PCG (P = 0.01) 20 (60%) JOAG eyes (P = 0.03), and 26 (65%) adult-onset POAG eyes (P = 0.23; χ2 test). Angle dysgenesis in the form of abnormal tissue at the angle/hyperreflective membrane and/or absence of SC could be identified on anterior segment SD-OCT, which can be used for in vivo evaluation of eyes with developmental glaucoma.