Early Three-Dimensional Intrableb Structural Changes in Primary-Open Angle Glaucoma and Exfoliation Glaucoma After...

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Outcomes

Background:

• Ex-PRESS glaucoma drainage devices are used to manage intraocular pressure (IOP).
• Understanding intrableb structural changes post-surgery is crucial for predicting success.
• Differences in glaucoma types, primary open-angle glaucoma (POAG) and exfoliation glaucoma (XFG), may influence surgical outcomes.

Purpose of the Study:

• To compare early-stage intrableb structural changes after Ex-PRESS surgery between POAG and XFG using anterior-segment optical coherence tomography.
• To investigate the relationship between intrableb structures and surgical success in these glaucoma types.

Main Methods:

• Anterior-segment optical coherence tomography was used to evaluate 40 eyes (25 POAG, 15 XFG) post-Ex-PRESS surgery.
• Intrableb images were classified into high-, medium-, and low-scattering walls and fluid-filled spaces.
• Surgical success was defined by IOP criteria (<18 mmHg and <15 mmHg) at 3 years.

Main Results:

• Exfoliation glaucoma (XFG) eyes had significantly smaller fluid-filled space volumes at 3 and 6 months postoperatively compared to primary open-angle glaucoma (POAG) eyes.
• In XFG eyes, a higher proportion of high-scattering walls correlated with increased IOP, while low-scattering walls correlated with decreased IOP.
• Three-year surgical success rates were significantly lower in XFG compared to POAG.

Conclusions:

• Early-stage intrableb structural differences, particularly smaller fluid-filled spaces in XFG, were observed after Ex-PRESS surgery.
• Changes in intrableb fibrosis, indicated by scattering intensity, may serve as a predictor of surgical outcomes in glaucoma.
• These findings highlight distinct structural responses to Ex-PRESS surgery in POAG and XFG, impacting long-term prognosis.