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Purpose <p>To compare anterior scleral thickness (AST) and aqueous outflow structure metrics Schlemm’s canal area (SCA), trabecular meshwork thickness (TMT), and scleral spur length (SSL) among primary open-angle glaucoma (POAG), ocular hypertension (OHT), and healthy eyes using spectral-domain OCT (SD-OCT), and to evaluate their inter-relationships.</p> Methods <p>In this prospective study, we included 126 participants (56 POAG, 24 OHT, 46 controls) from a tertiary glaucoma clinic (January–May 2025). One eye per subject was analysed. SD-OCT (REVO 60, Optopol, Poland) was used to obtain horizontal anterior-segment scans in nasal and temporal quadrants. AST was measured at 0–3 mm from the scleral spur (AST0–AST3); SCA, TMT, and SSL were quantified on exported images using Fiji/ImageJ with pixel-to-micron calibration. Group comparisons employed ANOVA/Kruskal–Wallis with post-hoc tests. Correlations and multiple linear regression assessed determinants of nasal AST0. Inter-observer repeatability was evaluated with ICC.</p> Results <p>Mean age was 67.9 ± 10.0 (POAG), 62.7 ± 10.4 (OHT), and 62.9 ± 6.6 years (controls). AST0 was significantly lower in POAG and OHT compared with controls in both nasal and temporal quadrants (all <i>p</i> &lt; 0.001). For AST3, temporal values were lower in POAG and OHT compared with controls (<i>p</i> &lt; 0.001), while nasal AST3 showed no significant group difference. SCA and SSL were significantly lower in POAG and OHT compared with controls in both quadrants (all <i>p</i> &lt; 0.001). TMT tended to be lower in patient groups but often did not reach significance. In multivariable analysis, nasal SCA and nasal SSL were independent positive predictors of nasal AST0 (both <i>p</i> &lt; 0.001; model R² = 0.356). Inter-observer ICCs ranged 0.78–0.93 (highest for nasal SCA = 0.93), indicating good repeatability.</p> Conclusions <p>POAG and OHT are characterised by a thinner anterior sclera and smaller Schlemm’s canal area and scleral spur length compared with controls. The independent association of SCA and SSL with AST supports a biomechanical coupling between the perilimbal sclera and outflow structures. These metrics warrant further longitudinal study for diagnostic/prognostic utility.</p>

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Spectral-domain OCT evaluation of anterior sclera and aqueous outflow structures in POAG, ocular hypertension, and healthy eyes

  • 期刊论文

  • 发表日期：

    2026年5月13日

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  • Mehmet Erol,
  • Berna Yuce,
  • Tuncay Kusbeci,
  • Atilim Armagan Demirtas

摘要

Purpose

To compare anterior scleral thickness (AST) and aqueous outflow structure metrics Schlemm’s canal area (SCA), trabecular meshwork thickness (TMT), and scleral spur length (SSL) among primary open-angle glaucoma (POAG), ocular hypertension (OHT), and healthy eyes using spectral-domain OCT (SD-OCT), and to evaluate their inter-relationships.

Methods

In this prospective study, we included 126 participants (56 POAG, 24 OHT, 46 controls) from a tertiary glaucoma clinic (January–May 2025). One eye per subject was analysed. SD-OCT (REVO 60, Optopol, Poland) was used to obtain horizontal anterior-segment scans in nasal and temporal quadrants. AST was measured at 0–3 mm from the scleral spur (AST0–AST3); SCA, TMT, and SSL were quantified on exported images using Fiji/ImageJ with pixel-to-micron calibration. Group comparisons employed ANOVA/Kruskal–Wallis with post-hoc tests. Correlations and multiple linear regression assessed determinants of nasal AST0. Inter-observer repeatability was evaluated with ICC.

Results

Mean age was 67.9 ± 10.0 (POAG), 62.7 ± 10.4 (OHT), and 62.9 ± 6.6 years (controls). AST0 was significantly lower in POAG and OHT compared with controls in both nasal and temporal quadrants (all p < 0.001). For AST3, temporal values were lower in POAG and OHT compared with controls (p < 0.001), while nasal AST3 showed no significant group difference. SCA and SSL were significantly lower in POAG and OHT compared with controls in both quadrants (all p < 0.001). TMT tended to be lower in patient groups but often did not reach significance. In multivariable analysis, nasal SCA and nasal SSL were independent positive predictors of nasal AST0 (both p < 0.001; model R² = 0.356). Inter-observer ICCs ranged 0.78–0.93 (highest for nasal SCA = 0.93), indicating good repeatability.

Conclusions

POAG and OHT are characterised by a thinner anterior sclera and smaller Schlemm’s canal area and scleral spur length compared with controls. The independent association of SCA and SSL with AST supports a biomechanical coupling between the perilimbal sclera and outflow structures. These metrics warrant further longitudinal study for diagnostic/prognostic utility.