Short-term effects of deep sclerectomy on retinal vessel density and visual field function in primary open-angle...

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Interventions

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Effective management strategies are crucial to slow disease progression and preserve vision.
• Non-penetrating deep sclerectomy (NPDS) is a surgical option to reduce intraocular pressure (IOP).

Purpose of the Study:

• To evaluate the immediate effects of Mitomycin C-augmented NPDS on retinal microvasculature and visual field function in POAG patients.
• To assess changes in intraocular pressure (IOP), visual field mean deviation (MD), and pattern standard deviation (PSD) post-surgery.
• To investigate the relationship between retinal vessel density (VD) and visual field parameters after NPDS.

Main Methods:

• A prospective, single-arm interventional study involving 22 eyes of 22 POAG patients.
• NPDS procedure performed on eyes with progressing glaucoma or uncontrolled IOP.
• Evaluations included IOP, Humphrey visual field (HVF) 30-2, RNFL, and OCTA-derived VD of the optic nerve head (ONH) and macula, measured pre- and one month post-surgery.

Main Results:

• A significant reduction in IOP from 23.5 mmHg to 8 mmHg (p<0.001) was observed one month post-operation.
• Visual field MD significantly improved from -15.44 dB to -13.06 dB (p=0.038), while PSD showed no significant change.
• No significant alterations in peripapillary or macular VD were detected, but post-op MD correlated positively with ONH and macular VD.

Conclusions:

• Mitomycin C-augmented NPDS is effective in significantly lowering IOP in POAG patients.
• The procedure did not demonstrate significant short-term changes in retinal microvasculature.
• A potential vascular mechanism underlying visual field defects in glaucoma is suggested by the correlation between retinal VD and visual field MD.