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. 2022 Oct;260(10):3321-3329.
doi: 10.1007/s00417-022-05644-3. Epub 2022 Apr 8.

Short-term changes in Bruch's membrane opening-based morphometrics during the first week after trabeculectomy

Caroline Gietzelt  1   2 , Jan-Niklas Lüke  3 , Werner Adler  4 , Thomas S Dietlein  3 , Alexandra Lappas  3 , Verena Prokosch-Willing  3 , Sigrid Roters  3 , Ludwig M Heindl  3 , Claus Cursiefen  3 , Philip Enders  3   5
Affiliations

Short-term changes in Bruch's membrane opening-based morphometrics during the first week after trabeculectomy

Caroline Gietzelt et al. Graefes Arch Clin Exp Ophthalmol. 2022 Oct.

Abstract

Purpose: To evaluate the dynamics of Bruch's membrane opening-based morphometrics of the optic nerve head (ONH) using spectral-domain optical coherence tomography (SD-OCT) during the first week after glaucoma surgery by trabeculectomy with mitomycin C.

Methods: Prospective, longitudinal analysis of 25 eyes of 25 patients treated by trabeculectomy. Twenty-four eyes had evaluable postoperative SD-OCT examinations. Bruch's membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness were analyzed at baseline before surgery, 1 day, 2 to 3 days, and 1 week after surgery. Changes compared to baseline were correlated to intraocular pressure (IOP).

Results: One day after surgery, the mean BMO-MRW changed by + 26.17 µm, p = 0.001 (mean IOP reduction by 17.01 mmHg). This increase persisted on day 2-3 with a mean increase of BMO-MRW of + 25.33 µm, p = 0.001 (mean IOP reduction by 20.46 mmHg) and by week 1 with a mean BMO-MRW increase of + 33.17 µm, p < 0.001 (mean IOP reduction by 22.55 mmHg). The increase in BMO-MRW correlated significantly with the reduction of IOP on day 1 (Spearman's rho ρ = 0.656, p = 0.003) and d2-3 (Spearman's rho ρ = 0.479, p = 0.038). There was no statistically significant correlation found between the IOP and the increase in BMO-MRW in week 1. RNFL thickness showed no significant changes at day 1 as well as days 2-3 (p ≥ 0.078, respectively). It showed a small but significant increase in week 1 by 3.94 µm, p = 0.015.

Conclusions: Structural reversal of disc cupping in BMO-MRW occurs as early as 1 day after trabeculectomy and correlates to the extent of the IOP reduction. During the whole first week after surgery, a strong increase in BMO-MRW can be noted. The changes in BMO-based parameters need to be considered when evaluating patients' longitudinal follow-up.

Keywords: Glaucoma; Optic coherence tomography; Optic nerve head; Trabeculectomy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Scatter plots showing a correlation between the increase in BMO-MRW and reduction in IOP on day 1, days 2–3, and week 1 after surgery. The line symbolizes a linear regression
Fig. 2
Fig. 2
Dynamics of mean BMO-MRW at baseline, on day 1, days 2–3, and at week 1: BMO-MRW significantly increases at all three follow up intervals after surgery compared to baseline before surgery
Fig. 3
Fig. 3
Dynamics of mean intraocular pressure (IOP) at baseline, on day 1, days 2–3, and at week 1
Fig. 4
Fig. 4
BMO-MRW of an exemplary patient 1 day after trabeculectomy. The black line a symbolizes the current BMO-MRW values, while the gray line and b symbolizes the baseline BMO-MRW. A significant increase in BMO-MRW can be seen
See this image and copyright information in PMC

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