Longitudinal quantitative assessment of macular retinal and choroidal remodeling after trabeculectomy in chronic primary angle-closure glaucoma using ultra-widefield SS-OCTA

To evaluate structural and microvascular changes in the macular retina and choroid of patients with chronic primary angle-closure glaucoma (CPACG) following trabeculectomy, using ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA). This prospective observational study included 40 eyes from CPACG patients undergoing trabeculectomy and 42 eyes from age- and sex-matched healthy controls. UWF SS-OCTA was used to quantify macular parameters including superficial vascular density (SVD) values, ganglion cell complex (GCC) thickness values, choroidal thickness (CT) values, choriocapillaris flow density (CCD) values, and choroidal vascularity index (CVI) values at baseline, 1 week, and 1 month postoperatively. At baseline, the CPACG group showed significantly reduced SVD, GCC thickness, and CVI values, along with diffusely increased CT values compared to healthy controls. After trabeculectomy, IOP was significantly reduced at both 1 week and 1 month. SVD and CVI values significantly improved by 1 month postoperatively, suggesting early microvascular recovery. CT values peaked at 1 week and declined by 1 month, while CCD values showed no significant changes. GCC thickness values remained stable postoperatively, indicating irreversible neuroaxonal damage. CPACG patients exhibit concurrent retinal-choroidal structural impairment and microcirculatory dysfunction. Trabeculectomy leads to partial reversal of microvascular deficits, particularly in SVD and CVI values. However, the irreversibility of neural damage highlights the necessity for early detection and timely intervention in CPACG management.