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Editors Selection IGR 17-4

Surgical Therapy: Reversal of lamina cribrosa displacement after trabeculectomy

Comment by George Spaeth on:

49279 Reversal of Lamina Cribrosa Displacement and Thickness after Trabeculectomy in Glaucoma, Lee EJ; Kim TW; Weinreb RN, Ophthalmology, 2012; 119: 1359-1366

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In 1869, around 19 years after the invention of the ophthalmoscope allowed looking into the eye, Von Jaeger published an atlas of magnificent drawings of the ocular fundus.¹ The new technology, ophthalmoscopy, rudimentary as it was and remains, has allowed marvelous new understandings of what constitutes health and disease.

Optical coherence tomography is a continuing example of mankind's ability to develop new technologies to understand reality. In ophthalmology the Rodenstock image analyzer may have been the first to use a slice of light shined onto the retina to provide a three dimensional view; better methods, including optical coherence tomography (OCT) resulted in relegation of the PAR, Rodenstock, and other imaging techniques to become historical curiosities. Further modification of 'spectral-domain OCT' has allowed what is, as of now, the most detailed method of obtaining an image of the retina in three dimensions in a clinical setting. But we can be sure that this too is but a step on the way to something better.

The article by Lee, Kim, and Weinreb using SD-OCT has shown that the lamina cribrosa of the optic nerve moves anteriorly (towards the cornea) when intraocular pressure is reduced in response to surgery.

This observation confirms those made by others, that cupping can decrease when intraocular pressure (IOP) is lowered.² There may be a level of IOP the optic nerve is able to withstand without developing damage. Noting when the lamina returns to its normal position may allow effective individualization of care.³ That is, it may be that documenting anterior movement of the lamina cribrosa may indicate when IOP has been lowered enough to prevent glaucomatous optic nerve damage.

It won't be too long before an even better form of OCT will allow clinicians to know how much the intraocular pressure needs to be lowered in order to give patients the best chance that their glaucomatous optic neuropathy will be stabilized.

My hunch is that it won't be too long before an even better form of OCT will allow clinicians to know how much the intraocular pressure needs to be lowered in order to give patients the best chance that their glaucomatous optic neuropathy will be stabilized.

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