Pilot study assessing the structural changes in posttrabecular aqueous humor outflow pathway after trabecular...

Area of Science:

• Ophthalmology
• Medical Imaging
• Glaucoma Research

Background:

• Glaucoma is a leading cause of irreversible blindness worldwide.
• Understanding aqueous humor outflow (AHO) pathway morphology is crucial for glaucoma management.
• Trabecular-targeted surgeries aim to improve AHO but their structural impact requires detailed evaluation.

Purpose of the Study:

• To evaluate morphological changes in AHO pathways post-glaucoma surgery using swept-source optical coherence tomography (SS-OCT).
• To assess both qualitative and quantitative changes in the posttrabecular AHO pathway.
• To investigate factors associated with AHO pathway alterations after surgery.

Main Methods:

• Prospective observational case series involving 15 eyes of glaucoma patients.
• Patients underwent Trabectome or suture trabeculotomy surgery.
• SS-OCT volumetric scans were used to reconstruct and analyze AHO pathway areas pre- and postoperatively (3-month follow-up).

Main Results:

• AHO pathways were visualized in 20 out of 30 analyzed regions.
• Qualitative assessment showed increased AHO in 8 regions, non-significant change in 9, and decreased in 3.
• Quantitative analysis revealed no significant change in average pathway area (3155±1633 vs. 3212±1684 pixels; P=0.50).

Conclusions:

• SS-OCT effectively visualizes intrascleral AHO pathways in glaucoma patients.
• Trabecular-targeted glaucoma surgery did not result in significant structural changes in the AHO pathway.
• Future studies should incorporate functional assessments of AHO to complement structural findings.