DIGITAL VISUALIZATION IN THE ASSESSMENT OF CORNEAL TRANSPARENCY IN GLAUCOMATOUS CHANGES

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 209 DIGITAL VISUALIZATION IN THE ASSESSMENT OF CORNEAL TRANSPARENCY IN GLAUCOMATOUS CHANGES Z.R. Nazirova1, D.M. Turakulova2, S.Sh. Kholmatova3, Sh.J. Islamkhodjaeva4 Tashkent State Medical University1,2,3,4 https://doi.org/10.5281/zenodo.17518450 Abstract. The congenital glaucoma is a leading etiologic factor in childhood visual impairment, accounting for 10 to 20% of childhood blindness cases. One of the most severe complications of this disease is glaucomatous keratopathy, a complex of morphofunctional corneal abnormalities induced by prolonged ocular hypertension and endothelial cell destruction. Reduced corneal optical transparency leads to a significant deterioration in visual function, complicates diagnostics, and is associated with an increased risk of adverse surgical outcomes. The data from 50 patients (91 eyes) aged birth to 15 years with glaucomatous keratopathy secondary to primary congenital glaucoma were analyzed. Quantitative assessment of corneal transparency was performed using digital image analysis using Fiji software. The analysis included the construction of corneal brightness histograms before and after surgery. Keywords: glaucomatous keratopathy, congenital glaucoma, antiglaucoma surgery, Fiji software, luminance histogram. Introduction. It is widely acknowledged that congenital glaucoma is considered one of the leading causes of blindness and visual impairment in children, and, according to the World Health Organization (WHO), accounts for a significant proportion (10–20%) of all cases of low vision in children [1, 7, 10]. According to several authors, statistics for Uzbekistan show that childhood blindness occurs at a rate of 1.6 per 10,000 children, and low vision at a rate of 3.5 per 10,000. It should be noted that approximately 55% of visual impairment occurs in young children [1, 2, 3, 4, 6]. The disease is primarily caused by structural anomalies in the anterior chamber angle (ACA) and the ocular drainage system, which impede or significantly impede the outflow of aqueous humor. Elevated IOP affects the ocular membranes, causing their stretching, deformation, and, as always, degenerative changes. As the disease progresses, changes in the retina and choroid increase, hemodynamics are disrupted, the retina thins, and morphological changes occur in all its layers. Pathological effects on the optic nerve head are undeniable; however, compensatory stretching of the eye partially offsets the impact of elevated IOP on the optic nerve. Despite this, glaucomatous optic neuropathy with optic nerve excavation occurs early in the disease. Research has consistently demonstrated that study by several authors has established that glaucomatous keratopathy is a significant sequelae of congenital glaucoma. This pathological complex arises from prolonged exposure to elevated intraocular pressure, which damages the corneal endothelial layer and disrupts its nutrition [3,4,5,8,9]. It has been extensively documented that the cornea loses its transparency and undergoes structural changes. Despite advances in the surgical treatment of primary congenital glaucoma, aspects of corneal structure and function in children still require more detailed study. In early childhood, corneal transparency plays a key role in the development of binocular vision and the prevention of amblyopia. However, in some clinical SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 210 cases, even after normal intraocular pressure has been achieved, persistent corneal clouding is observed, which becomes a barrier to successful visual rehabilitation [11,12,13]. The pathogenesis of glaucomatous keratopathy in children is multifaceted and multifactorial. Increased intraocular pressure leads to mechanical stretching of the corneal collagen matrix, degenerative changes in the Descemet membrane, and decreased endothelial cell density. These processes lead to the development of edema and thickening, ultimately resulting in impaired corneal transparency [10,14]. Anatomical features of the pediatric cornea, such as its high compliance, reduced biomechanical stability, and limited endothelial regenerative potential, exacerbate the pathological process [5,6]. In clinical practice, the impact of corneal changes on prognosis and treatment decisions for congenital glaucoma is often underestimated. Modern biomicroscopy and pachymetry methods only allow for a qualitative characterization of the degree of opacification but do not provide quantitative parameters of corneal transparency. The use of digital image analysis technologies, particularly Fiji software, offers promising opportunities for objective morphometric assessment of corneal health. Aim of the research: To objectively quantify corneal transparency in children with congenital glaucoma before and after glaucoma surgery using digital image analysis in the Fiji software environment. Materials and Methods: It is important to emphasize that from 2023 to 2025, 50 children aged birth to 15 years with primary congenital glaucoma with varying degrees of corneal opacities were examined. The study was conducted at the Ophthalmology Department of the TSMU Clinic. Patients with secondary or combined forms of glaucoma, as well as children with concomitant systemic diseases, were excluded from the study. It can be clearly observed that all children admitted on an emergency basis underwent glaucoma surgery after comprehensive preoperative preparation. In this study, we used a comprehensive approach, incorporating clinical, ophthalmological, functional, and laboratory research methods. The findings indicate that to accurately quantify corneal transparency, we used digital image analysis using specialized Fiji software (developed on ImageJ). Patients' eyes were photographed under standard conditions before and after glaucoma surgery. For each photograph, the corneal area corresponding to the pupil projection was manually identified. A luminance distribution histogram was then constructed for this area (Analyze → Histogram) [11, 12, 13]. The main parameters characterizing the degree of transparency and optical homogeneity of the cornea were the mean luminance (Mean), median luminance (Median), and standard deviation (StdDev). Results and interpretation. The study revealed the following distribution of patients by stage of congenital glaucoma: early stage was observed in 12 eyes (14%), advanced stage in 18 eyes (20%), advanced stage in 50 eyes (55%), and terminal stage in 11 eyes (11%). The anteroposterior axis (APA) length of the eye ranged from 21 mm in the early stage to 30 mm in the terminal stage. Microscopic examination revealed an increase in corneal diameter (12.0–14.0 mm) compared to the normal range in all children examined (91 eyes, 100%). The average corneal diameter was 12.6±0.3 mm, with a dilation ranging from 1.5 to 4.0 mm (average 2.5 mm). The analysis of digital images using Fiji software demonstrated that corneal transparency can be objectively measured. The luminance histogram, which displays the distribution of pixels by light intensity (0–255), served as an indicator of transparency (Fig. 1). A leftward shift of the SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 211 histogram peak indicated increased transparency (decreased luminance), while a rightward shift indicated decreased transparency (increased optical density and the presence of cloudiness). Fig. 1. The luminance histogram reflected the distribution of pixels by light intensity. Before surgery (Fig. 2), the average corneal luminance in patients with glaucomatous keratopathy was 132.3 units, the median was 129.0 units, and the standard deviation was 20.1 units. This corresponded to a second-degree reduction in transparency and significant structural heterogeneity. After surgery (Fig. 3), the values decreased to 89.65, 90.0, and 14.98 units, respectively, reflecting the restoration of transparency and a reduction in tissue optical variability. Fig. 2. Before surgery Fig. 3. After surgery The comparison of the histograms (Fig. 4) revealed a leftward shift of the distribution peak and a narrowing of the luminance range after surgery, indicating improved corneal lighttransmitting function. There is substantial evidence to suggest that biomicroscopic examination revealed a disappearance of swelling, partial pupil visibility, and the appearance of a pink fundus SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 212 reflex. When comparing keratopathy grades, the greatest improvement in transparency was observed in grades I–II (a 35–50% decrease in luminance), in grade III (up to 40%), while in grade IV the effect was limited (approximately 14%) (Fig. 5). Fig. 4. Histogram of corneal luminance distribution before and after surgery Figure 5. Brightness Decrease Conclusion. It is generally accepted that the effectiveness of surgical treatment is inversely proportional to the initial degree of opacity: the less severe the keratopathy, the higher the corneal restorative potential. These data underline that the use of digital image analysis and the construction of brightness histograms is an objective and reproducible method for quantitatively assessing corneal transparency. This method allows for the assessment of the dynamics of 35 - 50 % 40% 14% 0% 10% 20% 30% 40% 50% 60% I-II степени III -степени IV - степени I-II степени III -степени IV - степени SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 213 morphofunctional changes, the comparison of clinical outcomes, and serves as a reliable tool for monitoring the effectiveness of surgical treatment for glaucomatous keratopathy in children. REFERENCES 1. Sadovnikova, L.A., Glaucoma in Children. Moscow: Meditsina, 2014. pp. 15–28. 2. Henriques, R., Teixeira, S., Lira, M., Corneal Endothelial Cell Count in Primary Congenital Glaucoma. British Journal of Ophthalmology, 2004. Vol. 88, No. 4. - P. 503–507. 3. Mandal A.K., Netland P.A. Primary Congenital Glaucoma: Principles of Diagnosis and Management. - Berlin: Springer, 2010. - P. 112–138. 4. Walton D.S. Pediatric Glaucoma. 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