IMPORTANCE Vascular factors may have important roles in the pathophysiology of glaucoma. A practical method for the clinical evaluation of ocular perfusion is needed to improve glaucoma management.OBJECTIVE To detect peripapillary retinal perfusion in glaucomatous eyes compared with normal eyes using optical coherence tomography (OCT) angiography.

Purpose To compare optic disc perfusion between normal and glaucoma subjects using optical coherence tomography (OCT) angiography and detect optic disc perfusion changes in glaucoma. Design Observational, cross-sectional study. Participants Twenty-four normal subjects and 11 glaucoma patients were included. Methods One eye of each subject was scanned by a high-speed 1050 nm wavelength swept-source OCT instrument. The split-spectrum amplitude-decorrelation angiography algorithm (SSADA) was used to compute three-dimensional optic disc angiography. A disc flow index was computed from four registered scans. Confocal scanning laser ophthalmoscopy (cSLO) was used to measure disc rim area, and stereo photography was used to evaluate cup/disc ratios. Wide field OCT scans over the discs were used to measure retinal nerve fiber layer (NFL) thickness. Main Outcome Measurements Variability was assessed by coefficient of variation (CV). Diagnostic accuracy was assessed by sensitivity and specificity. Comparisons between glaucoma and normal groups were analyzed by Wilcoxon rank-sum test. Correlations between disc flow index, structural assessments, and visual field (VF) parameters were assessed by linear regression. Results In normal discs, a dense microvascular network was visible on OCT angiography. This network was visibly attenuated in glaucoma subjects. The intra-visit repeatability, inter-visit reproducibility, and normal population variability of the optic disc flow index were 1.2%, 4.2%, and 5.0% CV respectively. The disc flow index was reduced by 25% in the glaucoma group (p = 0.003). Sensitivity and specificity were both 100% using an optimized cutoff. The flow index was highly correlated with VF pattern standard deviation (R2 = 0.752, p = 0.001). These correlations were significant even after accounting for age, cup/disc area ratio, NFL, and rim area. Conclusions OCT angiography, generated by the new SSADA algorithm, repeatably measures optic disc perfusion. OCT angiography could be useful in the evaluation of glaucoma and glaucoma progression.

Purpose To detect macular perfusion defects in glaucoma using projection-resolved optical coherence tomography (OCT) angiography. Design Prospective observation study. Participants 30 perimetric glaucoma and 30 age-matched normal participants were included. Methods One eye of each participant was imaged using 6mm×6mm macular OCT angiography (OCTA) scan pattern by 70-kHz 840-nm spectral-domain OCT. Flow signal was calculated by the split-spectrum amplitude-decorrelation angiography algorithm (SSADA). A projection-resolved OCTA (PR-OCTA) algorithm was used to remove flow projection artifacts. Four en face OCTA slabs were analyzed: the superficial vascular complex (SVC), intermediate capillary plexus (ICP), deep capillary plexus (DCP) and all-plexus retina (SVC+ICP+DCP). The vessel density (VD), defined as the percentage area occupied by flow pixels, was calculated from en face OCTA. A novel algorithm was used to adjust the vessel density to compensate for local variations in OCT signal strength. Main Outcome Measures Macular retinal VD, ganglion cell complex (GCC) thickness, and visual field (VF) sensitivity. Results Focal capillary dropout could be visualized in the SVC, but not the ICP and DVP, in glaucomatous eyes. In the glaucoma group, the SVC and all-plexus retinal VD (mean±SD: 47.2%±7.1% and 73.5%±6.6%) were lower than the normal group (60.5%±4.0% and 83.2%±4.2%, both P <0.001, t test). The ICP and DCP VD were not significantly lower in the glaucoma group. Among the overall macular VD parameters, the SVC VD had the best diagnostic accuracy as measured by the area under the receiver operating characteristic curve (AROC). The accuracy was even better when the worse hemisphere (inferior or superior) was used, achieving an AROC of 0.983 and a sensitivity of 96.7% at a specificity of 95%. Among the glaucoma participants, the hemispheric SVC VD values were highly correlated with the corresponding GCC thickness and VF sensitivity (P<0.003). The reflectance compensation step in VD calculation significantly improved repeatability, normal population variation, and correlation with VF and GCC thickness. Conclusions Based on PR-OCTA, glaucoma preferentially affects perfusion in the SVC in the macula more than the deeper plexuses. Reflectance-compensated SVC VD measurement by PR-OCTA detected glaucoma with high accuracy and could be useful in the clinical evaluation of glaucoma.

Results Clinical outcome data were available for 1240 (85.3%) of cases. Early complications were reported in 578 (46.6%) cases and late complications in 512 (42.3%) cases. Some cases had more than one complication. The most frequent early complications were hyphaema (n ‫؍‬ 304, 24.6%), shallow anterior chamber (n ‫؍‬ 296, 23.9%), hypotony (n ‫؍‬ 296, 24.3%), wound leak (n ‫؍‬ 216, 17.8%) and choroidal detachment (n ‫؍‬ 175, 14.1%). The most frequent late complications were cataract (n ‫؍‬ 251, 20.2%), visual loss (n ‫؍‬ 230, 18.8%) and encapsulated bleb (n ‫؍‬ 42, 3.4%). The occurrence of most complications was not associated with a consultant's specialist interest, level of activity, type of hospital or region. Encapsulated bleb was reported more frequently in a university hospital setting. ConclusionsThe complication rates reported in this paper represent the national experience of first-time trabeculectomy for open angle glaucoma in the UK. These are similar to previous published studies and highlight in particular, the impact of trabeculectomy on visual acuity in the first year following surgery. This survey provides valid and clinically relevant data on the complications of trabeculectomy for the production of guidelines and standards for audit at regional, local and individual level.

During acute IOP elevation, functional changes progress from the proximal to the distal retina. Alterations in ganglion-cell-related ERG potentials occurred at IOPs (30-50 mmHg) commonly observed in rat experimental glaucoma models. Nonspecific functional changes were observed at acute IOP above 50 mmHg, suggesting that IOP should be maintained below this level in experimental glaucoma models if selective ganglion cell injury is to be sought. Repeated IOP spikes above this level may cause permanent, nonspecific damage, perhaps via ischemic mechanisms. Thus, IOP should be monitored frequently in these models.