Is Thicker Choroid a Risk Factor for Malignant Glaucoma?

Abstract

Purpose: The aim of this study was to evaluate the choroidal thickness (CT) and its determinants in primary angle closure glaucoma (PACG) eyes with and without malignant glaucoma (MG). Methods: In this cross-sectional study, we enrolled 25 patients with bilateral primary angle closure (PAC) diseases; 1 eye of each patient was diagnosed with PACG initially and later with MG after trabeculectomy, and the fellow eyes were diagnosed with PACG, PAC, or PAC suspect. Thirty-seven eyes from 37 PACG patients were recruited as controls. CT was measured at different locations (sub-fovea, 1 and 3 mm from the fovea) using spectral-domain optical coherence tomography. Comparisons of CT were made among MG, the fellow eyes, and the controls. The associations between the determinants and MG were analyzed by univariate and multiple logistic regression analysis. Results: Macular CT in the eyes with MG was thicker than that of the controls (p < 0.001) but not the fellow eyes. Thicker foveal CT was associated with an increased risk of MG (odds ratio 1.141). Conclusions: Thicker foveal CT is an anatomic risk factor for MG. The results of our study were consistent with the hypothesis that choroidal expansion may play a significant role for the development of MG.

Associations Between the Choroidal Vascularity Index and Malignant Glaucoma After Trabeculectomy for Primary Angle Closure Glaucoma

“…Additionally, in this study, a thicker SFCT was found to be an associated factor for eyes with MG after adjusting for age, sex, AL, and IOP. The result of a thicker SFCT was compatible with the findings of our previous study that the choroidal thickness in eyes with MG increased during the onset of MG compared with control eyes with uncomplicated PACG ( 7 ). Similarly, Quigley et al and Zhang et al provided an assumption that choroidal expansion could play a significant role in the pathogenesis of PACG and even MG, which probably increases pressure in each compartment of the eye, causing a shallow anterior chamber ( 3 , 4 , 36 ).…”

“…However, there were no significant differences in the CVI, TCA, LA, SA and the SFCT between eyes with MG and the fellow eyes with non-MG. The results indicated that the fellow eyes with non-MG may have a similar anatomic structure of the choroid as eyes with MG, representing a potentially high risk of MG disease ( 7 , 17 ).…”

“…Quigley et al have proposed that choroidal expansion may play a role in the pathogenesis of primary angle-closure glaucoma (PACG) and even MG (3,4). Recently, an increasing number of studies, including our previous reports, have demonstrated a thicker choroidal thickness in primary angle-closure diseases than in the non-glaucoma controls (5)(6)(7). However, many factors affect the choroidal thickness and it is relatively unstable (8).…”

Ocular Biometry of Primary Angle-Closure Disease in Younger Patients

“…These anatomical features of shorter AL, larger LV, and thinner and more anteriorly rotated ciliary body in younger PACD patients which are distinguished from the changing trend in normal people, might together lead to earlier onset of the disease. In addition, according to previous studies ( 7 , 8 , 21 , 34 ), these anatomical characteristics in young patients were also risk factors for the occurrence of malignant glaucoma after filtering surgery.…”

“…Ritch et al (5) defined "young" as "40 years old or younger" for the first time. Previous studies have found that younger PACD patients had a higher risk of malignant glaucoma after trabeculectomy (7,8), suggesting that the ocular biometric structure of younger patients might be different from that of older patients. However, most of the current studies on the ocular biometric parameters of PACD have focused on elderly patients (9)(10)(11)(12)(13)(14)(15)(16).…”