Visual field loss in primary congenital glaucoma Gautam Sinha, MD, Bharat Patil, MD, Ramanjit Sihota, MD, FRCS, Viney Gupta, MD, Bhagabat Nayak, MD, Reetika Sharma, MD, Ajay Sharma, BSc, and Neeraj Gupta, BSc PURPOSE To assess the visual field defects in primary congenital glaucoma (PCG) and to identify associated risk factors. METHODS In this cross-sectional study visual fields of consecutive PCG patients were examined using Humphery Field Analyzer (HFA) or Goldmann visual field (GVF). All patients had main- tained an intraocular pressure (IOP) #14 mm Hg on standard care. Mean deviation, pattern standard deviation (PSD), foveal threshold in HFA, and global visual field extent (degrees) in 24 meridians for targets V4e, I4e, I2e in GVF were recorded and evaluated with respect to baseline IOP and age at detection. Statistical analysis was performed by Kruskal Wallis and Mann-Whitney test. Qualitative analysis of GVF and reliable fields in HFA was performed. RESULTS A total of 100 eyes of 77 patients were included: 56 eyes of 47 patients were in the HFA group; 44 eyes of 30 patients, in the GVF group. On HFA, mean deviation detected at #1 month of age was significantly lower than eyes detected after 1 year (P \ 0.001). On GVF, the global visual field extent for target I4e and I2e was significantly lower for PCG de- tected at #1 month of age compared to those seen at .1 year (I4e, P \0.001; I2e, P 5 0.005). Mean deviation, PSD, and foveal threshold were significantly lower in PCG with baseline IOP of .30 mm Hg than with IOP of 20–25 mm Hg (mean deviation, P \ 0.001; PSD, P 5 0.002; foveal threshold, P 5 0.002). Extent for targets V4e and I4e on GVF were signif- icantly lower in patients with baseline IOP of .30 mm Hg compared to those with baseline IOP of 20–25 mm Hg (V4e, P 5 0.002; I4e, P 5 0.003). Definitive glaucomatous defects were found in 36 eyes (41%), most ommon being arcuate scotoma (19 eyes [22%]). CONCLUSIONS PCG detected at age #1 month and those having a baseline IOP of .30 mm Hg show greater visual field loss. ( J AAPOS 2015;19:124-129) P rimary congenital glaucoma (PCG), a major cause of blindness in children, 1 manifests at birth or in early childhood with corneal enlargement, corneal opacification, photophobia, and tearing. Medical manage- ment can be used as a temporarizing measure or adjuvant therapy, but surgery is generally required. Most studies on congenital glaucoma have reported intraocular pressure (IOP) over time and, less frequently, visual acuity. There are limited reports of perimetry in PCG, 2-8 even though visual field loss may adversely affect a child’s ability to function, and his or her quality of life. The purpose of the current study was to evaluate perimetry in a cohort of patients with PCG having a controlled IOP of #14 mm Hg to determine the kind of defects seen in congenital glaucoma and, secondarily, to correlate their severity with clinical risk factors. Subjects and Methods This cross-sectional study of consecutive patients with PCG treated at Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences on prospective, standard of care review, was undertaken over a 1-year period from 2013 to 2014. Only cooperative children .5 years of age with continuously controlled IOP (# 14 mm Hg) after management by trabeculectomy with trabeculotomy augmented by mito- mycin C, followed by use of antiglaucoma medications if necessary, and having a best-corrected visual acuity (Snellen) better than 6/60 were included. Exclusion criteria were the presence of any other ocular anomaly, corneal pathology, congenital cataract, uveitis, retinal disease, nystagmus, a rela- tive afferent pupillary defect or the absence of vision on exam- ination. The study was approved by the All India Institute of Medical Sciences Ethics Committee and adhered to the tenets of the Declaration of Helsinki. A written, informed consent was taken from participants above 18 years of age or from par- ents if the child was \18 years of age. Age-matched controls were examined to validate the reliability of perimetry and to obtain normative data. Controls were consec- utive patients with strabismus but no significant refractive error, amblyopia, or ocular pathology seen within the study period. All patients received comprehensive examinations, including slit-lamp biomicroscopy, applanation tonometry, fundus exami- nation with 90 D lens, pachymetry, and cycloplegic refraction. Author affiliations: Glaucoma Research Facility & Clinical Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Submitted April 7, 2014. Revision accepted December 26, 2014. Correspondence: Prof Ramanjit Sihota, MD, FRCS, FRCOphth, Head, Glaucoma Research Facility & Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi -110029 (email: rjsihota@hotmail.com). Copyright Ó 2015 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00 http://dx.doi.org/10.1016/j.jaapos.2014.12.008 124 Journal of AAPOS