Prediction of trabecular meshwork-targeted micro-invasive glaucoma surgery outcomes using anterior segment OCT angiography

Abstract

We performed a prospective, longitudinal study to investigate the association between the preoperative intrascleral vasculature assessed using anterior segment (AS)-optical coherence tomography angiography (OCTA) and surgical outcomes of trabecular meshwork-targeted micro- or minimally invasive glaucoma surgery (MIGS). We included 37 patients with primary open-angle glaucoma. Preoperative AS-OCTA images of the sclero-conjunctiva of the nasal corneal limbus were acquired in the superficial (conjunctival) and deep (intrascleral) layers. The vessel densities (VDs) of each layer were measured separately in the entire area, limbal side, and fornix area. Surgical success was determined by postoperative intraocular pressure (IOP) and IOP reduction. Twenty-three and 14 eyes were classified as having successful and unsuccessful outcomes, respectively. The deep VDs of the entire area and fornix area were significantly lower in the successful group (P = 0.031 and P = 0.009). The success rate was significantly higher for eyes with a lower deep VD than for eyes with a higher deep VD. A greater IOP reduction was significantly associated with lower deep VD in the fornix area (P = 0.022) and higher preoperative IOP (P < 0.001). These results indicate that intrascleral vasculature assessed using preoperative AS-OCTA was negatively correlated with surgical success and IOP reduction resulting from trabecular meshwork-targeted MIGS. AS-OCTA images might help predict MIGS outcomes.

Increased capillary stalling is associated with endothelial glycocalyx loss in subcortical vascular dementia

“…After equalization, vessels were segmented using the Weka trainable segmentation plugin in Fiji software (Supplementary Figure 1 C). [43][44][45][46] Shadows from large pial vessels were manually removed from the image. The vascular areas of the large pial vessels were measured.…”

Prediction of MIGS outcomes on second eyes using first eyes’ response

“…Recent studies have evaluated various aspects of patient and demographic characteristics associated with surgical success outcomes of different types of MIGS procedures. [5,6,18] To the best of our knowledge, this is the first study to evaluate first-eye outcomes at various postoperative time points as predictor factors of success in second-eye phaco-MIGS surgeries. We also analyzed the correlations in IOP and glaucoma medication change between fellow eyes as a predictive measure for second-eye IOP and glaucoma medication responses at 6 months postoperatively.…”

“…Previous investigative studies have evaluated a variety of tools to predict outcomes of MIGS, including anterior segment optical coherence tomography angiography for trabecular-meshwork targeted MIGS and a netarsudil trial for micropulse transscleral laser therapy. [5,6] Other studies have used fellow eye analysis to contrast the efficacy of various glaucoma surgical approaches. [7,8] While these studies highlight the utility of intra-patient comparison for assessing the efficacy of different surgical techniques, there is an absence of literature analyzing whether first-eye MIGS outcomes can predict outcomes in the second eye.…”

Катарактасы Бар Науқастарға Офтальмологиялық Көмек Көрсетуді Ұйымдастыруды Оңтайландыру

“…Данный метод помогает не только в оценке угла передней камеры, но и толщину роговицы, состояние стромы и эпителия, что имеет большое значение в подготовке и проведении хирургии [34][35][36][37]. При выявлении ранних симптомов глаукомы (не связанных с офтальмогипертензией) при помощи ОКТ и ОКТ-ангиографии как сетчатки, так и угла передней камеры, можно на этапе планирования лечения включить проведение малоинвазивных операции, которые можно провести одномоментно с факоэмульсификацией катаракты [38,39]. Последнее в дальнейшем послужит и для профилактики дальнейшей прогрессии глаукомы, значительно улучшив качество жизни пациента и экономические траты на повторные диагностические и лечебные процедуры.…”