Changes in Choroidal Thickness and Blood Flow Density before and after Endoscopic Cyclophotocoagulation Via Direct Internal Approach in Patients with Refractory Glaucoma and Their Correlation with Visual Improvement
Changes in Choroidal Thickness and Blood Flow Density before and after Endoscopic Cyclophotocoagulation Via Direct Internal Approach in Patients with Refractory Glaucoma and Their Correlation with Visual Improvement
Objective To investigate the changes of choroidal thickness and blood flow density in patients with refrac-tory glaucoma(RG)before and after endoscopic cyclophotocoagulation(ECP)via direct internal approach,and their correla-tion with visual improvement.Methods A total of 130 patients(130 eyes)with RG who were scheduled to undergo ECP via direct internal approach in our hospital from January 2021 to January 2023 were selected,the 130 affected eyes were used as the research group,and the 130 contralateral eyes were used as the control group.The choroidal blood flow density at 2 500 μm temporally from the fovea centralis(T2.5),and from the fovea centralis to the nasal side(N0.5-N2.5)as well as at T2.5 in the macular area were compared between the two groups before treatment as well as before treatment and at 6 months after treatment.The choroidal thickness and blood flow density in the macular area as well as the absolute values of their preoperative and postoperative changes in RG patients with different levels of visual improvement before and at 6 months after surgery were compared between the two groups.The correlation between choroidal thickness and blood flow density at T2.5 and N0.5-N2.5 in the macular area before surgery in the research group was analyzed,and the correlation of the abso-lute values of changes in choroidal thickness and blood flow density in the macular area before and after surgery with visual im-provement in affected eyes of patients with RG was analyzed.The value of the absolute values of changes in choroidal thickness and blood flow density at T2.5 in the macular area before and after surgery for visual improvement in RG patients undergoing ECP via direct internal approach was explored.Results Choroidal thickness and blood flow density at T2.5 and N0.5-N2.5 in the macular area of the research group were smaller or lower than those in the control group(P＜0.01),and choroid thick-ness at T2.5 and N0.5-N2.5 in macular area was positively correlated with blood flow density in the research group before sur-gery(P＜0.01).In the research group,the choroid thickness at T2.5 and blood flow density at 6 months after operation were greater or higher than those before surgery(P＜0.05).Macular choroid thickness at T2.5,blood flow density and absolute values of their changes were the greatest in patients with visual improvement at 6 months after surgery,followed by those with unchanged visual acuity and those with decreased visual acuity.Macular choroid thickness at T2.5,blood flow density and ab-solute values of their changes were positively correlated with visual improvement in RG patients(P＜0.05).Receiver operat-ing characteristic curve showed that the area under the curve of macular choroid thickness at T2.5,blood flow density and ab-solute values of their changes in combination in evaluating visual improvement in RG patients undergoing ECP via direct inter-nal approach was 0.911,which was greater than that of evaluation alone(0.760 and 0.829,respectively)(P＜0.05).Con-clusion The choroidal thickness and blood flow density in the macular area of the affected eye of RG patients became smaller or lower significantly at T2.5 and N0.5-N2.5,and there was a positive correlation between the two.After ECP via direct in-ternal approach,the choroidal thickness and blood flow density in the affected eye increased significantly at T2.5.The abso-lute value of changes in choroidal thickness at T2.5 and blood flow density before and after surgery were closely related to the improvement of vision.
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