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

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.