Trabeculectomy And Corneal Biomechanics: A Systematic Review And Meta-Analysis

Published 2025 - 43rd Congress of the ESCRS

Reference: PP17.11 | Type: Poster | DOI: 10.82333/k3ax-xp37

Authors: Carlos Augusto Ferraresi Sampaio* ¹ , Dillan Cunha Amaral ² , Carolina Trigo ³ , Matheus Leber ⁴ , Alexandre Júnior ⁵ , Pedro Lucas Magalhães ⁶ , Rodrigo Brazuna ⁷

¹Pontifical Catholic University of Paraná,Londrina,Brazil, ²Federal University of Rio de Janeiro,Rio de Janeiro,Brazil, ³Faculty of Medical Sciences of Santa Casa de São Paulo,São Paulo,Brazil, ⁴Federal University of Santa Maria,Santa Maria,Brazil, ⁵Faculty of Medicine of Marília,Marília,Brazil, ⁶Institute of Medical Education,Rio de Janeiro,Brazil, ⁷Federal University of the State of Rio de Janeiro,Rio de Janeiro,Brazil

Purpose

Glaucoma is a leading cause of irreversible blindness, characterized by progressive optic nerve damage and visual field loss. While intraocular pressure (IOP) is the primary modifiable risk factor, corneal biomechanics such as central corneal thickness (CCT), corneal hysteresis (CH), and a corneal resistance factor (CRF) have emerged as potential contributors to disease progression. Trabeculectomy, a standard surgical intervention for IOP reduction, has been shown to induce structural changes in the eye, yet its impact on corneal biomechanics remains underexplored. This study aims to assess the relationship between preoperative corneal biomechanical properties and postoperative changes in axial length following trabeculectomy.

Setting

Systematic review and meta-analysis.

Methods

The study was pre-registered in PROSPERO (CRD42024622909), and a systematic search was conducted in major databases, including PubMed, Embase, Cochrane Library, and Web of Science following PRISMA guidelines. The main outcomes of this review were CH, CRF, CCT, and different types of IOP measures. Eligible studies included randomized trials and observational studies reporting pre- and postoperative measurements with ≥1-week follow-up. Two independent reviewers extracted data and performed a random-effects meta-analysis, calculating mean differences with 95% CIs. Outcomes were stratified into early (≤1 month) and late (3–6 months) postoperative periods, no prostaglandin analog eye drops were used during this period.

Results

Eight studies, including 212 glaucoma patients undergoing trabeculectomy, met the inclusion criteria. The mean age was 63.07 years, with 56.60% male patients. CH significantly increased postoperatively, with an early rise of 1.32 (95% CI: 0.84–1.81; I²: 0%) and a late rise of 1.3 (95% CI: 0.72–1.89; I²: 30.7%). CRF showed a decreasing trend, but results were not statistically significant. IOPcc decreased by -16.30 mmHg (95% CI: -18.23; -14.37; I² = 0%) in the early postoperative period and -10.87 mmHg (95% CI: -15.06; -6.68; I² = 85.5%) in the late period. Goldmann IOP also declined significantly. Sensitivity analysis confirmed CH robustness, while heterogeneity remained high for CRF outcomes.

Conclusions

Trabeculectomy significantly increases CH, suggesting postoperative changes in corneal biomechanics. However, while IOPcc reduction was observed, its interpretation as a direct indicator of biomechanical modification remains uncertain, as a significant divergence between IOPcc and IOPGAT would be required to support this hypothesis. Despite a decreasing CRF trend, high heterogeneity limits interpretation. Corneal biomechanical changes may influence long-term surgical outcomes and glaucoma progression. Standardized prospective studies are needed to clarify their clinical impact and optimize surgical strategies for individualized glaucoma management.