Abstract
PurposeThe purpose of the study is to assess the displacement of lamina cribrosa (LC) and prelaminar tissue area (PTA) changes following trabeculectomy and non-penetrating deep sclerectomy (NPDS) using spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging technology.MethodsA total of 30 patients underwent glaucoma surgery. Sixteen patients underwent trabeculectomy, and 14 patients undertook NPDS. Serial horizontal B-scan images of optic nerve head (ONH) were obtained using SD-OCT preoperatively, and at 2-week, 1-, 3-, and 6-month postoperative visit (6 pv). LC displacement magnitude and PTA changes were determined from selected B-scan images. Correspondingly, OCT retinal nerve fiber layer (RNFL) parameters were measured.ResultsIntraocular pressure (IOP) decreased from 27.4 ± 10.3 mmHg (mean ± standard deviation) to 10.2 ± 4.0 mmHg (P = 0.011) and from 19.9 ± 4.0 mmHg to 11.9 ± 3.6 mmHg (P = 0.012) at 6 pv, for trabeculectomy and NPDS, respectively. There was a significant decrease in the LC depth from a baseline glaucomatous LC displacement of 468.0 ± 142.4 to 397.6 ± 125.2 μm in the trabeculectomy group (P = 0.001) and from 465.2 ± 129.6 to 412.0 ± 122.4 μm in the NPDS group (P = 0.029) at 6 pv. The PTA differed between the procedures at baseline (P = 0.002), but was not statistically significant postoperatively. Multivariate analysis for all patients including age, magnitude of IOP reduction, baseline glaucomatous LC displacement, magnitude of LC displacement, and the type of surgery revealed that only the magnitude of LC displacement was associated with significant RNFL thinning on average (r2 = 0.162, P = 0.027) and in the following sectors: temporal superior (r2 = 0.197, P = 0.014), temporal (r2 = 0.150, P = 0.034), and nasal superior (r2 = 0.162, P = 0.027).ConclusionsDecrease in the LC depth after NPDS surgery can be observed at 6 pv. Regardless of the performed procedure, magnitude of LC displacement is associated with significant, focal RNFL thinning.
Highlights
Glaucoma is a chronic, progressive optic neuropathy, in which there is degeneration of retinal ganglion cells with associated gradual loss of visual function
For the group of non-penetrating deep sclerectomy (NPDS), those differences were significant (P = 0.012) and amounted, on average, to 8.0 ± 6.1 mmHg. These amounts correspond to 59.8 ± 19.4 and 37.1 ± 25.9% reduction of Intraocular pressure (IOP) in the group of trabeculectomy and NPDS, respectively
The magnitude of lamina cribrosa (LC) displacement did not depend on age (r2 = 0.062, P = 0.185) and the type of surgery (r2 = 0.073, P = 0.362)
Summary
Progressive optic neuropathy, in which there is degeneration of retinal ganglion cells with associated gradual loss of visual function. The important role of LC structural changes began to surface through post mortem studies of glaucomatous eyes [6, 7] and use of animal models of experimentally induced glaucoma [8, 9]. With the development of the enhanced depth imaging technique using spectral-domain optical coherence tomography, which provides high-resolution images allowing visualization of individual cell layers, changes in the position of the LC and choroid have been studied in vivo. This technique has been used to evaluate the LC in both normal and glaucomatous subjects [10,11,12,13].
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