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Carlo Alberto Cutolo, Giorgia Taccone, Michele M Iester, Alessandro Bagnis, Chiara Bonzano, Chiara Pizzorno, Carlo Catti, Donatella Musetti, Carlo Enrico Traverso; Is the size of the trabecular meshwork associated with the efficacy of the selective laser trabeculoplasty?. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5242.
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Selective laser trabeculoplasty (SLT) treatment is supposed to work by modifying the metabolic activity and biomechanics of trabecular meshwork (TM). The laser spot is fixed at 400μm; this is considered large enough to cover the majority of the TM. We hypothesize that different sizes of TM might result in different percentages of tissue exposed to laser, causing a different response to treatment. We tested the hypothesis that TM dimensions measured by optical coherence tomography (OCT) affect the outcome of the SLT treatment.
A retrospective chart review of patients submitted to SLT for the treatment of open-angle glaucoma (OAG) that underwent previous OCT scans of anterior chamber angle (ACA) and with a minimum follow-up of 6 months was performed.Success was defined as ≥ 20% of pre-treatment IOP decrease or ≥1 medication reduction without additional IOP lowering procedures at six months post-treatment. The following TM measurements were obtained: TM’s length, TM maximum thickness, TM area. Other potential predictors studied were pretreatment IOP, age, gender, glaucoma stage, type of glaucoma, and the number of IOP-lowering medications. The associations between predictors and the outcome were assessed by logistic regression analysis.
Sixty-eight eyes were included in the analysis. The mean (sd) age was 73(21) years. 57 (84%) patients were affected by primary OAG, whereas 11 (16%) by pseudoexfoliative OAG. The measurements of the TM’s length, TM maximum thickness, and TM area were achieved in 75%, 80%, and 73% of cases, respectively. TM’s length, TM maximum thickness, and TM area were 734 (96) µm, 164(49) µm, and 0.089 (0.033) mm2, respectively. No TM meshwork measurement predicted the successful SLT. The only significant predictor was the pretreatment IOP (OR= 1.10; p= 0.021).
TM measurements were not associated with the outcome. SLT effect was predicted by higher pre-treatment IOP but not by other eye features or demographic data. OCT can be helpful as a complementary exam to gonioscopy to document the open-angle before treatment but failed to have a role in the prediction of effectiveness.
This is a 2020 ARVO Annual Meeting abstract.
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