Author: Adrián Sánchez-Fortún Sánchez (Spain)
Co-authors: Sandra Gomez Sánchez, Pau Romera Romero, Pamela Campos Figueroa, Pablo Diaz Aljaro, Jorge Loscos Arenas
To analyze subfoveal choroidal thickness changes using SD-OCT, maintained for 6 months, after a non-penetrating deep sclerectomy surgery and its correlation with intraocular pressure reduction.
Single-center prospective, interventional and longitudinal study designed at Germans Trias i Pujol Hospital, Ophthalmology Department, Retina and Glaucoma Service.
Pacients diagnosed with primary open-angle glaucoma (POAG) with progression signs of glaucoma despite maxima topical treatment and with indication of non-penetrating deep sclerectomy surgery (NPDS) were included in this study. Patients affected by other eye diseases, different types of glaucoma or with combined surgery indicated were excluded. All patients were evaluated in postoperative visits between three and six months, determining IOP using a Goldmann applanation tonometer and measuring choroidal thickness using EDI tool Cirrus SD-OCT (Carl Zeiss Meditec. Jena, Alemania) The variables used in the study were IOP and choroidal thickness as main variables and iridocorneal angle opening and visual field test parameters as secondary variables
A total amount of twenty-six eyes of twenty-six patients were included in this study (13 men and 13 women) with an average age of 68 ± 8,1 years old. Visual acuity changed from 0.75 ± 0.2 to 0.75 ± 0.23 (Snellen Chart). IOP decreased from 22.8 ± 4.9 mmHg to 12.6 ± 4.2 mmHg, reducing the need of eye-drops from 3.3 ± 1.1 on average to 0.1 ± 0.3. The previous mean choroidal thickness was 244.9 ± 61.8 microns and 280.38 ± 76.3 microns after surgery, being this increase significant (p = 0.012). We did not observe a significant correlation between the decrease in IOP and the increase in choroidal thickness (p = 0.67)
The decrease in intraocular pressure produced after glaucoma surgery (both trabeculectomy and NPDS, in our case) would produce an increase in choroidal thickness and, as a consequence, an increase in choroidal vascular flow. It is difficult to determine what implications choroidal flow has on retinal ganglion cell survival in glaucoma. Long-term studies are necessary to assess whether these changes would last over time