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Impact of ab-interno trabeculectomy on Bruch’s membrane opening-based morphometry of the optic nerve head for glaucoma progression analysis

  • Glaucoma
  • Published:
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Abstract

Purpose

To analyze the longitudinal change in Bruch’s membrane opening minimal rim width (BMO-MRW) and circumpapillary retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography (SD-OCT) after glaucoma surgery via ab-interno trabeculectomy in adult glaucoma patients.

Methods

Retrospective audit of 65 eyes of 65 participants undergoing ab-interno trabeculectomy using electroablation of the trabecular meshwork. In 53 eyes, surgery was combined with phacoemulsification and posterior chamber lens implantation. Pre- and postoperative SD-OCT examinations of the optic nerve head (ONH), intraocular pressure (IOP), and visual field data were analyzed. Longitudinal change in morphometric SD-OCT parameters of the ONH was compared and correlated to change in IOP and visual field function.

Results

BMO-MRW increased significantly between baseline (BL) and follow-up (FU) within the first 6 months after surgery (BL = 167.85 ± 90 μm; FU = 175.59 ± 89 μm; p = 0.034). This increase correlated with postoperative lowering of IOP (rho = − 0.41; p = 0.016). Nine months after surgery (range, 7–12 months), there was no significant change in BMO-MRW (BL = 196.79 ± 79; FU = 196.47 ± 85 μm; p = 0.95), while in later follow-up, a decrease of BMO-MRW was found (BL = 175.18 ± 78; FU = 168.65 ± 72; p = 0.05). RNFL thickness was unchanged in early (p > 0.16) and significantly decreased in later follow-up (p = 0.009). Mean deviation (MD) of visual field function did not show a significant change before and after surgery.

Conclusion

Electroablative ab-interno trabeculectomy leads to a significant transient mild increase in BMO-MRW. This increase was shown to correlate with IOP lowering. Significant loss of BMO-MRW in later follow-up may reflect insufficient IOP reduction by surgery. The parameters RNFL thickness and MD seem less impacted directly by surgery.

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Abbreviations

BCVA:

best-corrected visual acuity

BL:

baseline

BMO:

Bruch’s membrane opening

FU:

follow-up

GDD:

glaucoma drainage device

ILM:

inner limiting membrane

IOP:

intraocular pressure

M:

months

MD:

Mean deviation

MIGS:

microinvasive glaucoma surgery

MRW:

minimum rim width

MRA:

minimum rim area

ONH:

optic nerve head

RNFL:

retinal nerve fiber layer

SD:

standard deviation

SDOCT:

spectral domain optical coherence tomography

TOP:

tendency-oriented perimetry

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Acknowledgements

We thank all technical experts of our imaging laboratory and well as FOR 2240 “(Lymph-) Angiogenesis And Cellular Immunity In Inflammatory Diseases Of The Eye” for their support.

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Author notes

  1. Ludwig M. Heindl and Philip Enders are co-senior authors.

Authors and Affiliations

  1. Department of Ophthalmology, University Hospital of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany

    David Kiessling, Caroline Gietzelt, Friederike Schaub, Thomas S. Dietlein, Claus Cursiefen, Ludwig M. Heindl & Philip Enders

  2. Institute of Medical Statistics and Computational Biology (ISMB), University of Cologne, Cologne, Germany

    Hildegard Christ

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board (IRB)/Ethics Committee waived the need for approval due to local regulations on retrospective single-center studies.

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Kiessling, D., Christ, H., Gietzelt, C. et al. Impact of ab-interno trabeculectomy on Bruch’s membrane opening-based morphometry of the optic nerve head for glaucoma progression analysis. Graefes Arch Clin Exp Ophthalmol 257, 339–347 (2019). https://doi.org/10.1007/s00417-018-4187-2

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