Longitudinal OCT changes of the peripapillary RNFL after different glaucoma interventions - a comparative study

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Interventions

Background:

• Glaucoma management often involves surgical interventions to lower intraocular pressure (IOP).
• Different surgical techniques, including Trabeculectomy (TE), Deep Sclerectomy (DS), XEN microstent, and Preserflo (PF) microshunt implantation, are used for glaucoma.
• The impact of these procedures on the retinal nerve fiber layer (RNFL) requires detailed investigation.

Purpose of the Study:

• To compare the peripapillary retinal nerve fiber layer (pRNFL) thickness changes after four glaucoma surgeries: TE, DS, XEN, and PF implantation.
• To assess the long-term efficacy and safety of these surgical methods in managing primary open-angle glaucoma (POAG).

Main Methods:

• Retrospective analysis of 462 eyes with POAG undergoing TE, DS, XEN, or PF implantation.
• Data collected over two years included intraocular pressure (IOP), medication use, best-corrected visual acuity (BCVA), and pRNFL thickness via spectral domain optical coherence tomography (SD-OCT).

Main Results:

• All surgical groups showed a significant decrease in mean IOP and the number of IOP-lowering medications.
• Mean pRNFL thickness significantly decreased in all groups within the first postoperative year.
• No further statistically significant pRNFL decline was observed between years one and two post-surgery.

Conclusions:

• While effective in lowering IOP, glaucoma surgeries like TE, DS, XEN, and PF implantation are associated with pRNFL thinning in the initial postoperative year.
• The observed pRNFL thinning stabilizes by the second year, suggesting a potential adaptation or cessation of acute effects.