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Abstract：
OBJECTIVE: To evaluate structural alterations and healing responses in the trabecular meshwork region with optical coherence tomography (AS-OCT) following after gonioscopy assisted transluminal trabeculotomy (GATT) and microincisional trabeculectomy (MIT).
METHODS: 73 eyes of 67 patients (M:F = 45:22) with ≥6 months of follow-up after MIT (n = 41) or GATT (n = 32) with or without combined cataract surgery were included for this prospective study. The angle as seen on AS-OCT at 1, 3, 6 months after surgery were evaluated for structural alterations like peripheral anterior synechiae (PAS), hyphema, and hyperreflective scarring responses. The scarring was graded according to the linear extent measured from the centre of the trabecular meshwork (TM) gutter to the sclera/cornea as mild (<250μ), moderate (250-500μ), and severe(˃500μ), while the pattern of scarring was graded as open saucer/gutter, closed gutter, and trench pattern. The association of the need for medication or surgical outcome and clinical variables and AS-OCT parameters including the pattern and severity of scarring were analysed using multivariate regression.
RESULTS: All eyes achieved significant reduction of IOP and number of medications with a final IOP of 15±3.2mm Hg at a mean follow-up of 8±32. months. While mild scarring was seen more common in MIT, severe scarring was seen in >65% of GATT eyes compared to 31% of MIT eye, p<0.001. An open saucer was equally seen in MIT and GATT while the trench pattern was more commonly seen in GATT eyes (>50%). Severe scarring in a trench pattern seemed to predict the need for medications for IOP control, though they independently did not seem to influence the final IOP or surgical outcome.
CONCLUSIONS: A severe form of scarring in a trench pattern on AS-OCT predicted the need for glaucoma medications after MIGS surgery. Regular monitoring of the scarring responses by AS-OCT and clinical examination are necessary to identify those at need for medications after MIGS.
METHODS: 73 eyes of 67 patients (M:F = 45:22) with ≥6 months of follow-up after MIT (n = 41) or GATT (n = 32) with or without combined cataract surgery were included for this prospective study. The angle as seen on AS-OCT at 1, 3, 6 months after surgery were evaluated for structural alterations like peripheral anterior synechiae (PAS), hyphema, and hyperreflective scarring responses. The scarring was graded according to the linear extent measured from the centre of the trabecular meshwork (TM) gutter to the sclera/cornea as mild (<250μ), moderate (250-500μ), and severe(˃500μ), while the pattern of scarring was graded as open saucer/gutter, closed gutter, and trench pattern. The association of the need for medication or surgical outcome and clinical variables and AS-OCT parameters including the pattern and severity of scarring were analysed using multivariate regression.
RESULTS: All eyes achieved significant reduction of IOP and number of medications with a final IOP of 15±3.2mm Hg at a mean follow-up of 8±32. months. While mild scarring was seen more common in MIT, severe scarring was seen in >65% of GATT eyes compared to 31% of MIT eye, p<0.001. An open saucer was equally seen in MIT and GATT while the trench pattern was more commonly seen in GATT eyes (>50%). Severe scarring in a trench pattern seemed to predict the need for medications for IOP control, though they independently did not seem to influence the final IOP or surgical outcome.
CONCLUSIONS: A severe form of scarring in a trench pattern on AS-OCT predicted the need for glaucoma medications after MIGS surgery. Regular monitoring of the scarring responses by AS-OCT and clinical examination are necessary to identify those at need for medications after MIGS.
摘要：
目的：使用光学相干断层扫描（AS-OCT）评估房角镜辅助经腔小梁切开术（GATT）和微切口小梁切除术（MIT）后小梁网区的结构改变和愈合反应。
方法：本前瞻性研究纳入MIT（n=41）或GATT（n=32）术后随访≥6个月的67例患者（M：F=45：22）的73只眼。评估手术后1、3、6个月在AS-OCT上看到的角度的结构改变，如外周前粘连（PAS），前房积血,和过度反射的疤痕反应。根据从小梁网(TM)槽中心到巩膜/角膜测量的线性程度将瘢痕分级为轻度(<250μ),中等（250-500μ），和严重（500μ），虽然疤痕的图案被分级为开碟/排水沟，封闭的排水沟,和沟槽图案。使用多元回归分析药物或手术结果的需要与临床变量和AS-OCT参数(包括瘢痕形成的模式和严重程度)之间的关联。
结果：在平均8±32次随访时，所有眼睛均实现了IOP和药物数量的显着降低，最终IOP为15±3.2mmHg。月。虽然轻度疤痕在麻省理工学院更常见，在关贸总协定>65%的眼睛中看到严重的疤痕，而MIT的眼睛为31%，p<0.001。在麻省理工学院和关贸总协定中同样可以看到开碟，而在关贸总协定眼中更常见的是沟槽图案（>50％）。沟槽模式中的严重疤痕似乎预测了IOP控制药物的需要。尽管它们似乎独立地不影响最终的IOP或手术结果。
结论：在AS-OCT上呈沟槽状的严重形式的瘢痕预示了MIGS手术后青光眼药物的需要。有必要通过AS-OCT和临床检查定期监测瘢痕形成反应，以确定MIGS后需要药物治疗的患者。
方法：本前瞻性研究纳入MIT（n=41）或GATT（n=32）术后随访≥6个月的67例患者（M：F=45：22）的73只眼。评估手术后1、3、6个月在AS-OCT上看到的角度的结构改变，如外周前粘连（PAS），前房积血,和过度反射的疤痕反应。根据从小梁网(TM)槽中心到巩膜/角膜测量的线性程度将瘢痕分级为轻度(<250μ),中等（250-500μ），和严重（
结果：在平均8±32次随访时，所有眼睛均实现了IOP和药物数量的显着降低，最终IOP为15±3.2mmHg。月。虽然轻度疤痕在麻省理工学院更常见，在关贸总协定>65%的眼睛中看到严重的疤痕，而MIT的眼睛为31%，p<0.001。在麻省理工学院和关贸总协定中同样可以看到开碟，而在关贸总协定眼中更常见的是沟槽图案（>50％）。沟槽模式中的严重疤痕似乎预测了IOP控制药物的需要。尽管它们似乎独立地不影响最终的IOP或手术结果。
结论：在AS-OCT上呈沟槽状的严重形式的瘢痕预示了MIGS手术后青光眼药物的需要。有必要通过AS-OCT和临床检查定期监测瘢痕形成反应，以确定MIGS后需要药物治疗的患者。
