Relationship between corneal biomechanical properties and optic nerve head changes after deep sclerectomy.

Purpose: To evaluate corneal biomechanical properties and optic nerve head (ONH) changes following deep sclerectomy (DS) and the relation to each other.

Methods: Forty-nine eyes with primary open-angle glaucoma that underwent DS were studied. Corneal biomechanical properties were assessed using the Ocular Response Analyzer and the ONH was evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology before surgery and 3 months postoperatively. Changes in corneal hysteresis (CH), corneal resistance factor (CRF), optic nerve cupping, prelaminar tissue thickness, and lamina cribrosa depth and thickness were registered. A correlation matrix and multiple linear regression models were used to determine predictors of ONH changes.

Results: At 3 months after surgery, mean corneal compensated intraocular pressure (IOPcc) significantly decreased by 27.9% (p<00.001) and mean Goldmann-correlated IOP (IOPg) decreased by 30.52% (p<00.001). Mean CH increased and CRF decreased by 18.4% and 10.1%, respectively (p<00.001). There was a significant reversal of ONH cupping mainly due to a prelaminar tissue thickening (p<00.001). Significant associations were found between ONH cupping reversal and prelaminar tissue thickening with preoperative IOPcc (p = 0.046), IOPg (p = 0.02), and CRF (p = 0.002) and with changes in IOP, CH, and CRF (p<00.001, p = 0.004, p = 0.018, respectively) after surgery.

Conclusions: Corneal hysteresis increased and CRF decreased significantly 3 months after DS. Corneal resistance factor was the single largest preoperative factor influencing cupping reversal changes. Despite the influence of preoperative variables, postoperative IOP reduction was the only independent factor influencing changes observed in the ONH after surgery.