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Original Investigation |

Transient Ciliochoroidal Detachment After Ab Interno Trabeculotomy for Open-Angle Glaucoma A Prospective Anterior-Segment Optical Coherence Tomography Study

Tadamichi Akagi, MD, PhD1; Eri Nakano, MD1; Hideo Nakanishi, MD1; Akihito Uji, MD1; Nagahisa Yoshimura, MD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Japan
JAMA Ophthalmol. 2016;134(3):304-311. doi:10.1001/jamaophthalmol.2015.5765.
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Importance  Although trabeculotomy is a glaucoma surgical procedure for modest intraocular pressure (IOP) reduction, some eyes exhibit very low IOP during the early postoperative period. To our knowledge, the reason and its effect have not been investigated.

Objectives  To investigate ciliochoroidal detachment (CCD) immediately after ab interno trabeculotomy and evaluate its effect on IOP immediately after surgery.

Design, Setting, and Participants  This prospective, observational, case series was conducted at Kyoto University Hospital, Kyoto, Japan. Patients with open-angle glaucoma who underwent ab interno trabeculotomy using a microsurgical device by a single surgeon between July 1, 2014, and May 31, 2015, were included. Thirty-seven consecutive patients were enrolled, 33 of whom were included in the analysis. The dates of the analysis were August 1 to August 15, 2015.

Intervention  Imaging of CCD using anterior-segment optical coherence tomography (AS-OCT).

Main Outcomes and Measures  The incidence of CCD immediately after ab interno trabeculotomy and its effect on IOP in the early postoperative period.

Results  The study cohort comprised 33 patients. Their mean (SD) age was 69.4 (13.2) years, and 19 (58%) were male. At postoperative day 3, CCD was detected in 14 of 33 eyes (42%) (CCD group) using AS-OCT. The CCD group had shorter axial length (mean [SD], 23.66 [1.67] vs 25.16 [1.59] mm) and thinner central corneal thickness (mean [SD], 505.9 [35.8] vs 533.9 [39.1] μm) than the non-CCD group. Only 5 eyes had CCD at postoperative day 10, and 4 of these eyes had CCD at 1 month after surgery. The postoperative IOPs at all follow-up periods were lower in the CCD group than in the non-CCD group, but the difference in the postoperative IOPs between the groups decreased as time passed. The mean (SD) IOPs for the CCD group vs the non-CCD group were 9.1 (3.0) vs 14.2 (5.8) mm Hg at day 1, 8.4 (2.4) vs 13.4 (5.0) mm Hg at day 3, 11.0 (3.0) vs 15.5 (6.3) mm Hg at day 10, 13.4 (2.4) vs 15.5 (3.3) mm Hg at 1 month, and 13.9 (3.4) vs 15.5 (4.0) mm Hg at 3 months. In several eyes in the CCD group, the AS-OCT images revealed a connection between the CCD and the anterior chamber via the trabeculotomy site.

Conclusions and Relevance  Ciliochoroidal detachment after ab interno trabeculotomy was not rare and was associated with low IOP immediately after surgery. Postoperative CCD may be partially attributed to the transient increase in uveoscleral aqueous outflow via the trabeculotomy site.

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure 1.
Imaging Protocol and Preoperative and Postoperative Images of Anterior-Segment Optical Coherence Tomography

A, Imaging was performed independently in each of the 4 quadrants (superior, inferior, nasal, and temporal), as well as 30° superior and inferior at the nasal area. B-D, Images on the right are at the same location as the images on the left. The green arrowhead indicates the low-reflective area between the ciliochoroidal detachment and the anterior chamber; the blue arrowheads indicate the ablated region.

aIndicates ciliochoroidal detachment.

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Figure 2.
Time Course of IOP in Eyes With (CCD Group) vs Without (Non-CCD Group) CCD at Postoperative Day 3

CCD indicates ciliochoroidal detachment; IOP, intraocular pressure.

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Figure 3.
Representative High-Resolution Anterior-Segment Optical Coherence Tomography Images Generated Using Multiple-Scan Averaging

A, The left eye is shown. B, No ciliochoroidal detachment is observed before surgery. C-H, The Schlemm canal is visible (blue arrowhead). The yellow arrowhead shows that the ciliochoroidal detachment is connected to the ablation site. I, No ciliochoroidal detachment is seen. The ablation site (green arrowhead) seems to be covered by scar tissue.

aIndicates ciliochoroidal detachment.

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