Structural and Functional Associations of Macular Microcirculation in the Ganglion Cell-Inner Plexiform Layer in Glaucoma Using Optical Coherence Tomography Angiography.

PURPOSE: To quantify retinal microvasculature within the macular ganglion cell-inner plexiform layer (GCIPL) in primary open-angle glaucoma (POAG) and normal eyes, determine association of vessel parameters with structural and functional measures, and report diagnostic accuracy of vessel parameters. METHODS: POAG and normal patients underwent 6×6 mm macula scans [Angioplex optical coherence tomography angiography (OCTA); Cirrus HD-OCT 5000]; and Humphrey Field Analyzer II-i 24-2 visual field (VF). Prototype software performed semiautomatic segmentation to create GCIPL en face images, and quantified vessel area density (VAD), vessel skeleton density (VSD), and vessel complexity index (VCI) for the macula (globally, hemifields, and 6 focal sectors). Linear regression assessed association of OCTA parameters with VF mean deviation (MD) and GCIPL thickness globally and focally. RESULTS: A total of 34 POAG and 21 normal eyes were studied. VAD, VSD, and VCI were reduced in POAG versus normal (0.463 vs. 0.486, P=0.00029; 0.230 vs. 0.219, P=0.0014; 1.15 vs. 1.09, P=0.0044, respectively), with a trend of worsening with increased POAG severity. Reduced global VF MD was associated with reduced VAD and VCI, controlling for age and intereye correlation (P=0.0060, 0.0080; R=0.205, 0.211). Both superior and inferior hemifield MD were associated with corresponding VAD, VSD, and VCI (all P<0.007; R ranged from 0.12 to 0.29). Global GCIPL thickness was not associated with global OCTA parameters, and only inferior sector GCIPL thickness was associated with corresponding VAD, VSD, and VCI (P<0.05; R ranged from 0.15 to 0.16). Area under curves for VAD, VSD, and VCI were fair to good (0.83, 0.79, 0.82; respectively; P<0.0001). CONCLUSIONS: Glaucomatous eyes had reduced GCIPL microcirculation. OCTA parameters had stronger associations with functional rather than structural measures of glaucoma. This observation deserves further study.

Outcomes after DSEK in 101 eyes with previous trabeculectomy and tube shunt implantation.

PURPOSE: The aim of this study was to determine the outcomes after Descemet stripping endothelial keratoplasty (DSEK) in eyes with previous glaucoma surgery. METHODS: This is a retrospective review of all DSEK procedures performed by 2 surgeons from May 1, 2006, to December 31, 2012. RESULTS: Four hundred sixty-two DSEK procedures were performed, of which 113 (24%) were performed in 101 eyes after a trabeculectomy (52 procedures) and/or tube shunt implantation (76 procedures) (15 procedures in eyes with both). Primary graft failure and donor dislocation developed in 4.4% and 14.2% of cases in eyes with previous glaucoma surgery, not significantly different from the 3.2% (P = 0.56) and 11.5% (P = 0.51) in eyes without prior glaucoma surgery. During a mean follow-up of 20.7 ± 17.6 months, endothelial rejection developed in a greater percentage of eyes with previous glaucoma surgery (12.9%; 0.069/eye-year) compared with that in eyes without surgery (6.9%; 0.042/eye-year), although the difference was not statistically significant (P = 0.066 for percentage of eyes; P = 0.16 for rejection rate). Secondary graft failure developed in a significantly higher percentage of eyes with previous glaucoma surgery (15.9%; 0.094/eye-year) compared with that in eyes without surgery (3.2%; 0.019/eye-year) (P < 0.0001; P < 0.0001). Elevated intraocular pressure after DSEK was significantly more common in eyes with medically treated glaucoma (41.3%; 0.345/eye year) than in eyes with a previous glaucoma surgery (23.8%; 0.145/eye-year) and without glaucoma (20.0%; 0.138/eye year) (P = 0.009; P = 0.007). CONCLUSIONS: Although intraoperative and early postoperative complications such as donor dislocation and primary graft failure are not significantly more common after DSEK in eyes with previous glaucoma surgery, secondary graft failure is. In contrast, other postoperative complications such as elevated intraocular pressure are significantly more common in eyes with medically treated glaucoma than in eyes with previous glaucoma surgery and without glaucoma.