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Healing responses at the angle after micro-invasive glaucoma surgery-an AS-OCT study.

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Severe trench scarring on AS-OCT predicts the need for glaucoma medications after microinvasive glaucoma surgery (MIGS). Regular monitoring is essential for identifying patients requiring ongoing IOP management post-MIGS.

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Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Anatomic Pathology

Background:

  • Microinvasive glaucoma surgery (MIGS) aims to reduce intraocular pressure (IOP).
  • Understanding post-surgical healing in the trabecular meshwork (TM) is crucial for long-term outcomes.
  • Gonioscopy assisted transluminal trabeculotomy (GATT) and microincisional trabeculectomy (MIT) are common MIGS procedures.

Purpose of the Study:

  • To compare structural alterations and healing responses in the TM after GATT and MIT using AS-OCT.
  • To evaluate the impact of TM scarring on IOP control and medication needs post-MIGS.

Main Methods:

  • A prospective study included 73 eyes (67 patients) undergoing GATT or MIT.
  • AS-OCT imaging assessed TM structural changes, including peripheral anterior synechiae and hyperreflective scarring.
  • Scarring was graded by extent (mild, moderate, severe) and pattern (open saucer, closed gutter, trench).

Main Results:

  • Both GATT and MIT significantly reduced IOP and medication requirements.
  • Severe trench-pattern scarring was more prevalent after GATT (>65%) compared to MIT (31%).
  • Severe trench scarring predicted the need for IOP-lowering medications but did not independently affect final IOP or surgical success.

Conclusions:

  • Severe trench-pattern scarring observed on AS-OCT is a predictor of medication dependence post-MIGS.
  • AS-OCT monitoring of TM scarring is vital for identifying patients who may require continued medical management after MIGS.