Peripapillary Vessel Density Reversal after Trabeculectomy in Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Microvascular Imaging

Background:

• Glaucoma is characterized by optic nerve damage, often associated with impaired ocular blood flow.
• Intraocular pressure (IOP) is a primary risk factor for glaucoma progression.

Purpose of the Study:

• To assess microvascular changes in the peripapillary and optic disc regions after IOP reduction via trabeculectomy.
• To evaluate the impact of trabeculectomy on vessel density using OCT angiography in glaucoma patients.

Main Methods:

• 25 primary open-angle glaucoma (POAG) patients underwent trabeculectomy.
• Optical coherence tomography angiography (OCTA) was used to measure vessel density preoperatively and postoperatively (1 week, 1 month, 3 months).
• Analysis included whole image, peripapillary, nasal, and temporal regions; vessel density reversal was calculated.

Main Results:

• Mean IOP decreased significantly from 30.92 mmHg to 12.64 mmHg at 3 months post-surgery.
• Significant increases in whole vessel density and peripapillary vessel density (PvD) were observed at 3 months.
• The extent of vessel density reversal correlated with higher preoperative IOP and greater IOP reduction.

Conclusions:

• Trabeculectomy leads to a significant increase in peripapillary vessel density, as shown by OCT angiography.
• The observed reversal of peripapillary vessel density is associated with preoperative IOP levels and the degree of IOP reduction.
• These findings suggest that reducing IOP can improve ocular perfusion and potentially slow glaucoma progression by restoring microvasculature.