Clinical and diagnostic aspects of glaucomatous keratopathy in congenital glaucoma

Despite advances in early diagnosis and surgical treatment of primary congenital glaucoma, the condition of the cornea, including opacity, endothelial dysfunction, and persistent edema, often remains underestimated, although it largely determines residual vision and the effectiveness of visual rehabilitation. Objective. The study aimed to determine clinical and diagnostic criteria for glaucomatous keratopathy in children and to develop a classification to improve the effectiveness of diagnosis and treatment. Material and methods. We examined 360 children with congenital glaucoma in the ophthalmology department of the Tashkent State Medical University Clinic from 2021 to 2025. The study group consisted of 209 boys (58.2%) and 151 girls (41.8%). All patients underwent ophthalmic examination. Results. Depending on the area of opacity and the degree of corneal transparency, glaucomatous keratopathy was divided into 4 degrees. Grade 1 is characterized by opacity in the form of Haab’s striae and mild edema ranging from 1 to 4 mm in the central cornea. The iris pattern and pupil are clearly visualized, and fundus details can be seen. Grade 2 is characterized by stromal edema and corneal opacity measuring 5 to 8 mm, the iris pattern is visible peripherally, the pupil is visualized, a faint pink fundus reflex is present, and fundus details cannot be identified. Grade 3 is characterized by severe corneal opacity exceeding 8.5 mm, the anterior chamber and iris pattern are visible only at the periphery, the pupil is not visible, and the fundus reflex is absent. Grade 4 is characterized by total corneal opacity and edema. The anterior chamber, iris pattern, and pupil are not visible. The fundus reflex is absent. The limbal borders cannot be identified. Keratectasia is observed. Conclusion. The authors’ classification of glaucomatous keratopathy systematizes previously fragmented descriptions of corneal changes, allowing objective assessment of their severity and prediction of postoperative dynamics.