Abstract
Purpose :
The nasal sector of the anterior chamber angle has been described as presenting a higher density of collector channels, which may influence the results of minimally invasive glaucoma surgery. Considering potential anatomical differences in the aqueous humor drainage system, we compare the results of the nasal and temporal 180-degree selective laser trabeculoplasty (SLT) treatment in patients with open-angle glaucoma.
Methods :
The charts of all patients with primary open-angle glaucoma, pigmentary glaucoma or pseudoexfoliation glaucoma who underwent a 180-degree SLT treatment between December 2016 and October 2018 were retrospectively reviewed. One experienced ophthalmologist (JSP) performed all procedures, and the nasal (N1) or temporal (T1) sector were chosen at his discretion. Patients who did not experience intraocular pressure (IOP) decrease within the first 6 months were retreated with 180-degree SLT in the opposite angle sector (T2 and N2). Main outcome measured was IOP decrease at the 3 months follow-up. Data were analyzed using ANOVA with Bonferroni's post-test. A multivariable regression analysis was also performed using age, diagnosis, baseline IOP, number of eyedrops, and angle sector treated as covariables.
Results :
Forty-five eyes of 31 patients (19 men), aged 54.3±11.8 years underwent at least one SLT session. The procedure was done initially in the nasal or the temporal sector in 23 and 18 eyes respectively, and repeated in the opposite angle sector in 19 eyes (nasal = 11; temporal =8 eyes). The only significant differences in IOP decrease (mean IOP decrease = -3.0±1.3 mmHg; ANOVA p= 0.014) was observed between N1 and T1 (-1.99 mmHg), N2 (-2.15 mmHg) and T2 (-2.36 mmHg). Only baseline IOP (p=0.021) and the angle sector (N1; p=0.044) correlated with IOP decrease.
Conclusions :
180-degree SLT performed initially in the nasal sector is associated with greater IOP decrease compared to the temporal sector approach. Considering the potential sectorial differences in the drainage system, further prospective randomized clinical trials are warranted to confirm our findings and compare nasal 180-degree to 360-degree SLT.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.