The Role Of Anterior Scleral Structures In The Etiopathogenesis Of Neovascular Glaucoma: A Pilot Clinical Study

Neovascular glaucoma (NVG) is a severe secondary glaucoma characterized by poor visual prognosis, and its etiopathogenesis has not yet been fully elucidated. The aim of this study was to evaluate anterior scleral thickness (AST) in patients with NVG and to compare AST measurements between NVG-affected eyes and fellow non-NVG eyes in order to explore potential structural biomarkers associated with disease progression.

University of Health Science Haseki Training and Research Hospital, Istanbul, Turkey

This pilot study included NVG-affected eyes and fellow non-NVG eyes of 15 patients. Anterior scleral thickness was measured using swept-source optical coherence tomography (SS-OCT) at the level of the scleral spur (AST0) and at 1 mm (AST1), 2 mm (AST2), and 3 mm (AST3) posterior to the scleral spur. Measurements were performed manually by identifying the inner and outer scleral boundaries. Demographic characteristics, best-corrected visual acuity, and intraocular pressure were also recorded. Comparisons between NVG and control eyes were performed using paired t-tests.

The mean age of the patients was 69.5 ± 4.6 years; 5 patients were female and 10 were male. Mean visual acuity was 0.11 in NVG eyes and 0.47 in control eyes. Mean intraocular pressure was 27.14 mmHg in NVG eyes and 20.00 mmHg in control eyes. In the NVG group, mean AST values were 646.64 µm at AST0, 599.79 µm at AST1, 597.07 µm at AST2, and 584.14 µm at AST3. Corresponding values in control eyes were 652.00 µm, 590.43 µm, 608.50 µm, and 619.07 µm, respectively. Statistical analysis demonstrated a significant difference between NVG and control eyes only at the AST3 measurement point (p = 0.02).

Anterior scleral thickness in NVG eyes showed a progressive decrease with increasing distance from the limbus, with significantly thinner sclera at 3 mm posterior to the scleral spur compared with control eyes. This finding suggests that anterior scleral thinning may play a role in the etiopathogenesis of NVG and could represent a potential structural biomarker. Larger prospective studies are warranted to further clarify this association.