Comparison of conjunctival vascularity changes using optical coherence tomography angiography after trabeculectomy and phacotrabeculectomy

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 257; no. 10; pp. 2239 - 2255
• Main Authors: Seo, Je Hyun, Lee, Young, Shin, Jong Hoon, Kim, Ye An, Park, Keun Heung
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2019; Springer Nature B.V
• Subjects: Aged; Angiography; Brightness; Cataract - complications; Cataracts; Color; Conjunctiva - blood supply; Female; Fluorescein Angiography - methods; Follow-Up Studies; Fundus Oculi; Glaucoma; Glaucoma - diagnosis; Glaucoma - surgery; Humans; Intraocular Pressure - physiology; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Mitomycin C; Ophthalmology; Phacoemulsification - methods; Postoperative Period; Reproducibility of Results; Retrospective Studies; Surgery; Surgical outcomes; Tomography; Tomography, Optical Coherence - methods; Trabeculectomy - methods; Glaucoma; Vascularity; Phacotrabeculectomy; Optical coherence tomography angiography; Conjunctiva
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-019-04412-0

Purpose
To compare bleb vascularity changes using optical coherence tomography angiography (OCT-A) between mitomycin-C (MMC)-augmented trabeculectomy and phacotrabeculectomy and to determine whether bleb vascularity measurements during preoperative and early postoperative periods could act as surrogate parameters to predict surgical outcomes.
Methods
We retrospectively reviewed data for 72 eyes from 72 glaucoma patients who underwent MMC-augmented trabeculectomy with/without cataract surgery. Bleb area scans were obtained using OCT-A during the preoperative period; 1, 2, 4, and 6 weeks postoperatively; and 2, 4, and 6 months postoperatively. For conjunctival vascularity analysis, a semi-automated program was used to calculate color and brightness densities of the selected area.
Results
Color and brightness densities were decreased in the trabeculectomy group during all periods but not in the phacotrabeculectomy group at 4 and 6 weeks, as well as 2, 4, and 6 months postoperatively. Color and brightness densities were significantly higher in the phacotrabeculectomy group than in the trabeculectomy group after 6 weeks and 2, 4, and 6 months postoperatively. A Kaplan-Meier survival graph indicated that intraocular pressure differed according to glaucoma type but not surgery type. Logistic regression analysis revealed that brightness density 1 week postoperatively was correlated with reoperation.
Conclusions
Changes in conjunctival vascularity density measured by OCT-A differed according to the surgical method. Following trabeculectomy with MMC, brightness density 1 week postoperatively may be a predictive index for surgical outcomes.