Microvascular Changes in Peripapillary and Optic Nerve Head Tissues After Trabeculectomy in Primary Open-Angle Glaucoma.
Kim Ji-Ah, Kim Tae-Woo, Lee Eun Ji, Girard Michaël J A, Mari Jean Martial
AI Summary
Trabeculectomy increased deep optic nerve head vessel density, primarily in the lamina cribrosa, which correlated more with reduced lamina cribrosa curvature than IOP reduction, suggesting improved blood flow in this critical area.
Abstract
Purpose
To determine microvasculature changes in the deep optic nerve head (ONH) and peripapillary tissues after trabeculectomy, and to correlate these with changes in the lamina cribrosa (LC) curvature.
Methods
Fifty-six eyes with primary open-angle glaucoma that underwent trabeculectomy were included. The optic nerve and peripapillary microvasculature were evaluated in en face images obtained using optical coherence tomography (OCT) angiography (OCTA) before and 3 months after trabeculectomy. The OCTA-derived vessel density (VD) was calculated in each layer segmented into the prelaminar tissue (PLT), LC, peripapillary retina (PR), and peripapillary choroid (PPC). Swept-source OCT volume scanning of ONH was performed on the same day as OCTA to examine the change in LC curvature quantified as the LC curve index (LCCI).
Results
At 3 months postoperative, the IOP and LCCI had significantly decreased (both P < 0.001). OCTA images revealed a significant increase in VD in the LC (P = 0.006), but not in the PLT, PR, or PPC. Twenty-six eyes showed both significant LCCI decrease and VD increase based on 95% Bland-Altman limits of agreement. The VD increase in the LC was significantly associated with larger percentage reductions in IOP (P = 0.040) and LCCI (P < 0.001) in the univariate analysis. Multivariate analysis revealed that only the LCCI reduction was a significant factor affecting the VD increase in the LC.
Conclusions
A significant increase in VD was observed at the level of the LC after trabeculectomy. The VD increase was more strongly associated with the reduction in the LC curvature than with the reduction of IOP.
MeSH Terms
Shields Classification
Key Concepts4
In 56 eyes with primary open-angle glaucoma that underwent trabeculectomy, intraocular pressure (IOP) and lamina cribrosa curve index (LCCI) significantly decreased at 3 months postoperative (both P < 0.001).
In 56 eyes with primary open-angle glaucoma that underwent trabeculectomy, optical coherence tomography angiography (OCTA) revealed a significant increase in vessel density (VD) in the lamina cribrosa (P = 0.006) at 3 months postoperative, but not in the prelaminar tissue, peripapillary retina, or peripapillary choroid.
In 56 eyes with primary open-angle glaucoma that underwent trabeculectomy, the increase in vessel density (VD) in the lamina cribrosa was significantly associated with larger percentage reductions in intraocular pressure (P = 0.040) and lamina cribrosa curve index (P < 0.001) in univariate analysis.
In 56 eyes with primary open-angle glaucoma that underwent trabeculectomy, multivariate analysis revealed that only the lamina cribrosa curve index (LCCI) reduction was a significant factor affecting the vessel density (VD) increase in the lamina cribrosa.
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