Swept-source optical coherence tomography quantitative scoring system accurately predicts postoperative intraocular pressure control and visual outcomes in primary angle-closure glaucoma.

OBJECTIVE

To evaluate the clinical utility of the swept-source optical coherence tomography (SS-OCT) scoring system in the long-term management of primary angle-closure glaucoma (PACG).

METHODS

Clinical data of 136 PACG patients (155 eyes) who underwent phacoemulsification combined with goniosynechialysis between June 2021 and July 2023 were retrospectively analyzed. Based on intraocular pressure (IOP) one year postoperatively, patients were categorized into a controlled group (IOP < 21 mmHg, 85 patients, 98 eyes) and an uncontrolled group (IOP ≥ 21 mmHg, 51 patients, 57 eyes). SS-OCT was used to assess retinal nerve fiber layer (RNFL) thickness, optic disc parameters, Schlemm's canal morphology, angle opening distance at 500 μm (AOD500), trabecular-iris angle at 500 μm, and visual acuity. Logistic regression analysis was performed to identify factors influencing postoperative IOP control.

RESULTS

The uncontrolled group showed higher IOP and lower RNFL thickness than the controlled group (P < 0.05). After treatment, the uncontrolled group exhibited higher cup-to-disc area ratio and diameter ratios than the controlled group (P < 0.05). Schlemm's canal diameter (SCD), Schlemm's canal area (SCA), and AOD500 were significantly lower in the uncontrolled group both before and after treatment (P < 0.05). Pre-treatment IOP was negatively correlated with SCD, SCA, and AOD500 (r < 0, P < 0.05). Elevated IOP was identified as a risk factor for postoperative IOP control in PACG patients (OR > 1, P < 0.05).

CONCLUSION

The SS-OCT scoring system accurately quantifies postoperative IOP control, RNFL thickness, optic disc parameters, and visual function changes in PACG patients, providing guidance for personalized treatment.