Photo Credit: Alex Mit
In a study on the impact of trabecular meshwork pigmentation on combined minimally invasive glaucoma surgery (MIGS) outcomes, higher pigmentation correlated with certain glaucoma characteristics, but didn’t predict success in MIGS.
The following is a summary of “Effect of Preoperative Trabecular Meshwork Pigmentation and Other Eye Characteristics on Outcomes of Combined Phacoemulsification/MIGS,” published in the January 2024 issue of Ophthalmology by Chan et al.
The study aimed to investigate the connection between pigmentation of the trabecular meshwork (PTM) alongside other preoperative eye traits and the outcomes of combined minimally invasive glaucoma surgery (MIGS) with phacoemulsification (Phaco/MIGS). It involved analyzing PTM, intraocular pressure (IOP), IOP-lowering medications, and visual acuity (VA) data concerning Phaco/MIGS results.
This investigation encompassed 265 eyes (from 172 patients, mean age 73.5 [SD, 10.0], range 35-95 years, 40.0% male), categorized into high PTM (108 eyes, 40.8%) and low PTM (157 eyes, 59.2%) groups. The high PTM group exhibited elevated preoperative IOP (16.7 [SE 0.4] vs. 15.2 [0.4] mmHg, p=0.009), included more cases of primary open-angle glaucoma (POAG, p=0.03), fewer instances of normal-tension glaucoma (NTG, p=0.01), and fewer cases of mild stage glaucoma (p=0.001) than the low PTM group. In comparison to the baseline, the final IOP reduced by 6.5 [2.4]% and 13.4 [3.0]% (p=0.075) to 13.5 [0.3] mmHg and 13.6 [0.4] mmHg (p=0.77) in the low and high PTM groups, respectively. Additionally, IOP-lowering medications were reduced by 34.6 [4.9]% (n=116) and 18.1 [7.3]% (n=85) in the low and high PTM groups, respectively (p=0.062). Surgical success rates were 59.9% and 58.3%, respectively (p=0.87). Surgical success correlated positively with higher preoperative IOP (Hazard Ratio 1.08 [95% CI 1.04-1.12] p<0.0001) and a greater number of preoperative IOP medications (1.20 [1.05-1.37] p=0.007), and negatively with a history of Selective Laser Trabeculoplasty (SLT, 0.40 [0.23-0.68] p=0.0009) and longer axial length (0.87 [0.80-0.94], p=0.0006), but was not linked to PTM.
In conclusion, while higher PTM correlated with POAG rather than NTG and more severe glaucoma with higher preoperative IOP, it did not correlate with Phaco/MIGS success. Surgical success was associated positively with higher preoperative IOP and a greater number of IOP medications and negatively with a history of SLT and longer axial length. These insights may assist glaucoma surgeons in planning surgeries and counseling patients.
Source: sciencedirect.com/science/article/abs/pii/S2589419624000085