PurposeTo evaluate changes in peripapillary and macular choroidal thickness (CT) as well in optic nerve head (ONH) including prelaminar tissue, lamina cribrosa and optic disc cupping following deep sclerectomy (DS) and to analyze the relationship between these parameters and intraocular pressure (IOP) change.MethodsProspective observational study involving glaucomatous eyes undergoing DS. ONH was evaluated by Spectralis optical coherence tomography (OCT) and enhanced depth imaging (EDI) technology. CT was automatically measured with swept‐source – OCT Triton at the macula (fovea, inner and outer ring) and at four peripapillary locations. All OCTs were performed before surgery and at 1 week postoperatively and changes in choroid and ONH postoperatively were calculated. Linear regression models were used to determine predictors of choroidal changes including age, IOP change, and axial length (AL).ResultsThirty‐two eyes of 32 patients undergoing DS were included (mean age: 71.9 ± 9.4). There was a significant reversal of ONH cupping after DS (p = 0.001). The mean choroidal thicknesses significantly increased compared to preoperatively (p = 0.002 for average peripapilar, p = 0.000 for four locations around the optic disc and p = 0.000 for all nine macular sectors). Mean pCT thickening was inversely correlated with the mean IOP change (rho −0.754, p = 0.000). Mean cupping reversal significantly correlated with both mean prelaminar tissue thickening and pCT thickening (rho: −0.832, p = 0.000 and rho: −0.582, p = 0.012 respectively).ConclusionsBesides the well‐known ONH morphological changes following IOP reduction after DS, peripapillary and macular choroid significantly thickened early after DS. Larger studies with longer follow‐up are necessary to establish if these changes remain stable over time.