Uveoscleral Outflow Routes after MicroPulse Laser Therapy for Refractory Glaucoma: An Optical Coherence Tomography Study of the Sclera
Articolo
Data di Pubblicazione:
2024
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 baseline
and after six months. MP-TLT success was defined as an intraocular pressure (IOP) reduction by
one-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 was
the 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. At
6 months, the median IOP reduction was 21% in the failures and 38% in the successes. The baseline
S-MISHA, I-MISHA, and T-MISHA did not differ between the groups, while S-SR and T-SR were
higher 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. Given
the partial correlation between these modifications and post-treatment IOP reduction, our study
confirmed that the activation of the uveoscleral AH outflow route could significantly contribute to
the IOP lowering after MP-TLT.
Tipologia CRIS:
1.1 Articolo in rivista
Keywords:
refractory glaucoma; uveoscleral aqueous humor outflow; MicroPulse transscleral laser
treatment; MP-TLT; anterior segment-OCT; intraocular pressure
Elenco autori:
Agnifili, Luca; Palamini, Andrea; Brescia, Lorenza; Porreca, Annamaria; Oddone, Francesco; Tanga, Lucia; Ruggeri, Maria Ludovica; Quarta, Alberto; Mastropasqua, Rodolfo; Di Nicola, Marta; Mastropasqua, Leonardo
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