To analyze in vivo scleral changes induced by MicroPulse transscleral laser therapy (MPTLT) in refractory glaucoma using anterior segment–optical coherence tomography (AS-OCT). Fortytwo candidate patients for MP-TLT were consecutively enrolled and underwent AS-OCT at baselineand after six months. MP-TLT success was defined as an intraocular pressure (IOP) reduction byone-third. The main outcome measures were the mean superior (S-), inferior (I-), and total (T-)intra-scleral hypo-reflective space area (MISHA: mm2) and scleral reflectivity (S-SR, I-SR, T-SR;arbitrary scale) as in vivo biomarkers of uveoscleral aqueous humor (AH) outflow. The IOP wasthe secondary outcome. The relations between the baseline-to-six months differences (D) of DSMISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, DT-SR, and DIOP, were investigated. At6 months, the median IOP reduction was 21% in the failures and 38% in the successes. The baselineS-MISHA, I-MISHA, and T-MISHA did not differ between the groups, while S-SR and T-SR werehigher in the successes (p < 0.05). At six months, successful and failed MP-TLTs showed a 50%increase in S-MISHA (p < 0.001; p = 0.037), whereas I-SR and T-SR reduced only in the successes(p = 0.002; p = 0.001). When comparing DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR,and DT-SR, there were no significant differences between the groups. In the successful procedures,DIOP was positively correlated with DT-MISHA and DI-MISHA (ρ = 0.438 and ρ = 0.490; p < 0.05).MP-TLT produced potentially advantageous modifications of the sclera in refractory glaucoma. Giventhe partial correlation between these modifications and post-treatment IOP reduction, our studyconfirmed that the activation of the uveoscleral AH outflow route could significantly contribute tothe IOP lowering after MP-TLT.
Uveoscleral Outflow Routes after MicroPulse Laser Therapy for Refractory Glaucoma: An Optical Coherence Tomography Study of the Sclera
Porreca, Annamaria;
2024-01-01
Abstract
To analyze in vivo scleral changes induced by MicroPulse transscleral laser therapy (MPTLT) in refractory glaucoma using anterior segment–optical coherence tomography (AS-OCT). Fortytwo candidate patients for MP-TLT were consecutively enrolled and underwent AS-OCT at baselineand after six months. MP-TLT success was defined as an intraocular pressure (IOP) reduction byone-third. The main outcome measures were the mean superior (S-), inferior (I-), and total (T-)intra-scleral hypo-reflective space area (MISHA: mm2) and scleral reflectivity (S-SR, I-SR, T-SR;arbitrary scale) as in vivo biomarkers of uveoscleral aqueous humor (AH) outflow. The IOP wasthe secondary outcome. The relations between the baseline-to-six months differences (D) of DSMISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, DT-SR, and DIOP, were investigated. At6 months, the median IOP reduction was 21% in the failures and 38% in the successes. The baselineS-MISHA, I-MISHA, and T-MISHA did not differ between the groups, while S-SR and T-SR werehigher in the successes (p < 0.05). At six months, successful and failed MP-TLTs showed a 50%increase in S-MISHA (p < 0.001; p = 0.037), whereas I-SR and T-SR reduced only in the successes(p = 0.002; p = 0.001). When comparing DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR,and DT-SR, there were no significant differences between the groups. In the successful procedures,DIOP was positively correlated with DT-MISHA and DI-MISHA (ρ = 0.438 and ρ = 0.490; p < 0.05).MP-TLT produced potentially advantageous modifications of the sclera in refractory glaucoma. Giventhe partial correlation between these modifications and post-treatment IOP reduction, our studyconfirmed that the activation of the uveoscleral AH outflow route could significantly contribute tothe IOP lowering after MP-TLT.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
