Abstract
Purpose :
To compare the level of post-operative aqueous flare between minimally invasive glaucoma surgeries (Preserflo & Miniject), Cataract, Cataract + Endocyclophotocoagulation (ECP) and filtration surgeries (Trabeculectomy & Baerveldt Tube) through objective measurement of anterior chamber flare. There is a paucity of published information on objective measurement of flare in the post-operative period for new approaches to managing glaucoma. Sub-clinical inflammation is not always apparent without objective measurements and this study aims to highlight levels of long- term inflammation for these common surgical approaches.
Methods :
Retrospective data collected from Guys and St Thomas’ NHS Foundation Trust between July 2019 to September 2023. KOWA FM-600 Laser Flare Meter was used to assess flare. Mean flare for each device was calculated at 1 weeks, 3 months, 6 months and 1 year.
Results :
Preserflo mean flare at week 1 was 42.64 (SD 49.43) and at 1 year was 15.43 (SD 8.9). Baerveldt Tube mean flare at week 1 was 28.65 (SD 26.35) and at 1 year was 44.65 (SD 40.63). Trabeculectomy mean flare at week 1 was 61.27 (SD 68.81) and at 1 year was 33.45 (SD 30.97). Miniject mean flare at week 1 was 92.25 (SD 81.10) and at 1 year was 11.97 (SD 6.10). Cataract mean flare at week 1 was 34.42 (SD 27.40) and at 1 year was 13.82(9.61). Cataract & ECP mean flare at week 1 was 60.75 (SD 49.78) and at 1 year was 26.43 (SD 24.32).
Image Caption [Post-Operative Flare: 1 Week ,1 month, 3 months, 6 months and 1 year for each procedure July 2019-September 2023]
Conclusions :
The flare meter provides an accurate, reproducible, non-invasive assessment of aqueous flare which can be valuable in research and clinical decisions. The observed rise in flare at 1 month for Tubes is most likely associated with the removal of intraluminal stent. Our data suggests that sub-clinical inflammation persists in tubes and least with suprachoroidal devices (Miniject). The contrast in inflammation between different IOP lowering devices (Preserflo, Miniject and Baervaeldt Tube) is likely to be influenced by the biomaterial. Sub-clinical inflammation seems to persist up to a year, if not longer and recognising this may direct appropriate long-term management of surgical cases. This study recognises the need for prospective glaucoma clinical trials to include objective flare assessment within their study design.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.