Evidence of Post Trabeculectomy Optic Nerve Reperfusion by OCT Angiography

Abstract

Aim: To describe a case of glaucoma which showed increase in optical coherence tomography (OCT) angiographic vessel densities after intraocular pressure reduction suggesting reperfusion of optic nerve. Presentation of Case: A 55 year old female with primary open angle glaucoma was taken up for trabeculectomy in view of inadequate control of intraocular pressure (IOP) despite maximal medical therapy. In addition to routine glaucoma assessment by visual fields and nerve fiber layer assessment by OCT, OCT angiographic evaluation of peripapillary vessel density was done preoperatively. Three months after trabeculectomy, her intraocular pressure decreased from 35mmHg to 14mmHg. Compared with the preoperative baseline value, the vessel density increased significantly in all quadrants after three months from surgery as demonstrated by OCT angiography. Discussion: This case report suggests that decreased optic nerve head perfusion due to high IOP can be reversed by reduction of IOP. Conclusion: Vascular parameters like angiographic vessel density can show reversible changes as decreased blood flow reinstates and thus can be better prognostic indicators than structural parameters like OCT retinal nerve fiber layer (RNFL) in glaucoma patients.