Long-term Longitudinal Changes in Choroidal Thickness with Intraocular Pressure Reduction after Glaucoma Surgery

Inhye Kim; Won Mo Gu; Areum Jeong; Soon Cheol Cha

doi:10.3341/jkos.2020.61.1.69

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Kim, Gu, Jeong, and Cha: Long-term Longitudinal Changes in Choroidal Thickness with Intraocular Pressure Reduction after Glaucoma Surgery

Original Article

Journal of the Korean Ophthalmological Society 2020; 61(1): 69-77.

Published online: 15 January 2020

DOI: https://doi.org/10.3341/jkos.2020.61.1.69

Long-term Longitudinal Changes in Choroidal Thickness with Intraocular Pressure Reduction after Glaucoma Surgery

Inhye Kim, MD¹, Won Mo Gu, MD², Areum Jeong, MD¹, Soon Cheol Cha, MD, PhD¹

¹Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea.

²Daegu Premier Eye Center, Daegu, Korea.

Address reprint requests to Soon Cheol Cha, MD, PhD. Department of Ophthalmology, Yeungnam University Hospital, #170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: 82-53-620-3442, Fax: 82-53-626-5936, sccha@ynu.ac.kr

Received 16 May 2019 Revised 23 July 2019 Accepted 30 December 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We investigated the long-term longitudinal changes in axial length (AL), mean ocular perfusion pressure (MOPP), and choroidal thickness (CT) according to the reduction of intraocular pressure (IOP) after glaucoma surgery. The potential variables associated with CT changes were also evaluated.

Methods

This was a prospective study for 1 year after glaucoma surgery, which included 71 eyes of 71 patients with primary open-angle glaucoma. The subfoveal CT (SFCT) and peripapillary CT (PPCT) were measured using spectral-domain optical coherence tomography preoperatively and 1 week, 1 month, 2 months, 6 months, and 1 year postoperatively. MOPP was calculated from the IOP and blood pressure. The AL was measured using partial coherence interferometry. Regression analysis was conducted to assess the possible association of variables.

Results

The AL decreased and the MOPP, SFCT, and PPCT increased significantly with IOP reduction at 1 year post-operatively (all, p < 0.001). The changes in SFCT and PPCT were significantly associated with IOP reduction at 1 year postoperatively (r = −0.519 and r = −0.528, respectively). Importantly, greater increases in SFCT and PPCT were found in patients with IOP reduction more than 30% from baseline, when compared with those with less than 30% reduction (p = 0.001 and p = 0.002, respectively). The SFCT increased more significantly in patients with AL ≤ 24 mm, compared with patients with AL > 24 mm (p = 0.044).

Conclusions

Reduction in the IOP, increase in the MOPP, decrease in the AL, and increase in the CT after glaucoma surgery persisted for 1 year during a long-term follow-up. These results suggested that glaucoma surgery reduced mechanical compression on the optic nerve fiber and increased intraocular blood flow.

Keywords: Axial length, Choroidal thickness, Glaucoma surgery, Intraocular pressure, Ocular perfusion pressure

Figures and Tables

Figure 1

Obtaining choroidal thickness (CT). The choroid is seen in cross-section on an enhanced-depth imaging optical coherence tomography scan. CT is defined as space between up-pointing arrow and down-pointing arrow. The outer border of the retinal pigment epithelium to the inner border of the sclera (arrowheads). (A) The subfoveal choroidal thickness (SFCT); SFCT was measured at subfovea, 250 µm nasal to the fovea, and 250 µm temporal to the fovea. (B-D) The peripapillary choroidal thickness (PPCT); PPCT was measured at 1,000 µm nasal and temporal side (B), superior (C) and inferior side (D) from the optic disc center.

Figure 2

Scatter spot showing associations of changes in intraocular pressure (IOP) and choroidal thickness (CT) at preoperative and 1 year postoperative. (A) Changes in IOP and subfoveal CT at preoperative and 1 year postoperative showed a significant negative correlation (r = −0.519, p < 0.001). (B) Changes in IOP and peripapillary choroidal thickness at preoperative and 1 year postoperative showed a significant negative correlation (r = −0.528, p < 0.001). SFCT = subfoveal choroidal thickness; PPCT = peripapillary choroidal thickness. ^*Simple correlation analysis.

Table 1

Baseline demographics and clinical characteristics of subjects (n = 71)

Categorical variables are reported using proportions and continuous variables are reported using mean ± standard deviation (range) or number (%) unless otherwise indicated.

SE = spherical equivalent; HTN = hypertension; DM = diabetic mellitus.

Table 2

One-year longitudinal changes of ocular parameter at preoperative and postoperative periods

Values are presented as mean ± standard deviation (range).

IOP = intraocular pressure; AL = axial length; MOPP = mean ocular perfusion pressure; SFCT = subfoveal choroidal thickness; PPCT = peripapillary choroidal thickness.

^*Repeated measured analysis of variance.

Table 3

Analyses of potential factors associated with changes in choroidal thickness at 1 year postoperatively

SFCT = subfoveal choroidal thickness; PPCT = peripapillary choroidal thickness; HTN = hypertension; DM = diabetic mellitus; IOP = intraocular pressure; AL = axial length; MOPP = mean ocular perfusion pressure; Preop = preoperative; ED = eye drop; postop = postoperative.

^*Simple linear regression analysis; ^†multiple linear regression analysis.

Table 4

Changes in ocular parameters according to amount of IOP reduction at 1 year postoperatively

Values are presented as mean ± standard deviation.

IOP = intraocular pressure; postop = postoperative; SFCT = subfoveal choroidal thickness; PPCT = peripapillary choroidal thickness; AL = axial length.

^*Subgroup with intraocular pressure reduction more than 30% from the baseline IOP; ^†subgroup with intraocular pressure reduction less than or equal to 30% from the baseline IOP; ^‡independent-sample t-test.

Table 5

Changes in ocular parameters according to baseline axial length at 1 year postoperatively

Values are presented as mean ± standard deviation.

AL = axial length; IOP = intraocular pressure; SFCT = subfoveal choroidal thickness; PPCT = peripapillary choroidal thickness.

^*Subgroup with preoperative axial length less than or equal to 24 mm; ^†subgroup with preoperative axial length greater than 24 mm; ^‡independent-sample t-test.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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