Corneal Morphology And Visual Quality After Non-Penetrating Deep Sclerectomy: Epithelial Remodeling, Asphericity And Functional Vision Outcomes

To evaluate corneal structural and optical changes after non-penetrating deep sclerectomy (NPDS), focusing on epithelial remodeling, corneal asphericity, and functional visual outcomes including uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA).

Tertiary referral center for glaucoma and anterior segment surgery.

Prospective observational study including 42 eyes of 42 patients undergoing NPDS. Preoperative and 6-month postoperative assessments included UCVA, BCVA (logMAR), corneal tomography, anterior segment optical coherence tomography, epithelial thickness mapping, and corneal asphericity (Q value, 6-mm zone). Central and sectorial epithelial thickness changes were analyzed and correlated with visual acuity outcomes.

Mean UCVA improved from 0.38 ± 0.21 logMAR preoperatively to 0.30 ± 0.19 logMAR postoperatively (p = 0.04). Mean BCVA remained stable (0.12 ± 0.10 vs 0.11 ± 0.09 logMAR; p = 0.62). Central epithelial thickness increased by 1.9 ± 1.4 µm (p < 0.01), with predominant inferior epithelial thickening. Mean corneal asphericity shifted toward a more prolate profile (Q value −0.21 ± 0.08 to −0.27 ± 0.09; p = 0.03). No clinically relevant changes in corneal curvature or endothelial-related parameters were observed. Changes in UCVA correlated with epithelial thickness redistribution (r = 0.41; p = 0.01).

NPDS induces significant corneal epithelial remodeling and mild changes in corneal asphericity without compromising BCVA. Functional visual stability appears to be primarily related to epithelial redistribution rather than stromal or endothelial alterations, supporting the corneal safety and refractive neutrality of NPDS.