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28.11.2018 | Glaucoma

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

Graefe's Archive for Clinical and Experimental Ophthalmology
David Kiessling, Hildegard Christ, Caroline Gietzelt, Friederike Schaub, Thomas S. Dietlein, Claus Cursiefen, Ludwig M. Heindl, Philip Enders
Wichtige Hinweise
Ludwig M. Heindl and Philip Enders are co-senior authors.



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.


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.


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.


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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