En face optical coherence tomography detection of Schlemm's canal in primary open angle glaucoma

Purpose: To compare the morphological characteristics of Schlemm's canal (SC) in patients with primary open-angle glaucoma (POAG) and healthy controls, using swept-source optical coherence tomography (SS-OCT) with en face reconstruction. Methods: In this Prospective comparative study, we included 100 eyes from 50 patients diagnosed with POAG and 50 healthy controls. Three-dimensional cube and line scans of the temporal and nasal quadrants of the anterior segment of the limbus were acquired using SS-OCT. SC was identified using en face and cross-sectional images. The diameter and area of SC in cross-sectional images and the visible percentage and area of SC in en face images were measured using ImageJ. Results: SC was observed in 84% of en face images and 81% of cross-sectional images in eyes with POAG but in 92% of en face images and 86% of cross-sectional images in control eyes. Significant differences between the POAG and normal control eyes were found in the en face area (0.35 ± 0.14 mm² vs. 0.56 ± 0.22 mm² in the temporal quadrant and 0.36 ± 0.14 mm² vs. 0.58 ± 0.23 mm² in the nasal quadrant; both p < 0.001) and visible percentage of SC (85.71% vs. 94.91% and 87.10% vs. 95.52% in the temporal and nasal quadrant respectively, both p < 0.001) in en face images as well as the cross-sectional area (2790.9 ± 942.2 μm² vs. 4138.6 ± 2027.8 μm² in the temporal quadrant and 2805.7 ± 947.2 μm² vs. 4224.0 ± 2002.2 μm² in the nasal quadrant, both p < 0.001) and diameter of SC (123.1 ± 25.4 μm vs. 149.5 ± 34.7 μm in the temporal quadrant and 126.3 ± 28.9 μm vs. 155.3 ± 36.0 μm in the nasal quadrant, both p < 0.001) in cross-section images. In addition, the mean intraocular pressure (IOP) significantly correlated with the en face area, visible percentage of SC, and cross-sectional area in the temporal and nasal quadrants. Conclusion: SS-OCT can obtain high-quality en face images of SC without post-acquisition processing. Eyes with POAG had a decreased en face SC area compared with normal eyes. A correlation between SC area, visible percentage of en face images, and IOP was also observed.