Outcomes of ab-interno irrigating goniectomy with trabectome in primary and secondary glaucoma from a single center in India.

Purpose: This study was done to report intermediate-term outcomes of irrigating goniectomy with trabectome (trabectome) surgery among different types of glaucoma eyes from a single center in India using a cross-sectional, longitudinal, observational study design. Methods: Fifty-three patients (58 eyes) with glaucoma who underwent irrigating goniectomy with trabectome between January 2019 and February 2020 were included. Pre-operative data included age, gender, eye laterality, specific diagnosis, number of anti-glaucoma medications (AGMs), prior glaucoma surgeries, visual acuity, and intraocular pressure (IOP) on medical treatment. Post-operative data included IOP changes during the follow-up till 1-year, number of AGMs, any complications, or additional surgical intervention required. Success was defined as IOP ≤ 21 mmHg and ≥ 20% reduction of IOP from pre-operative IOP with no additional glaucoma surgery. Results: The cohort included 58 eyes (male 53.4% and female 46.6%) ranging from 0.6 to 81 years of age. The average baseline IOP was 23.4 ± 10.2 mmHg and reduced significantly with surgery to 14.1 ± 5.3 mmHg at 1-year follow-up. The AGMs reduced from 2.4 ± 1.4 pre-surgery to 1.6 ± 1.4 at 1-year follow-up. Four eyes required additional glaucoma surgeries for IOP control. The success rate of trabectome with phacoemulsification (88%) was discernibly higher than with trabectome alone (67%). Intra-operatively, significant blood reflux was noticed in 27 eyes, of which only one required tamponading with a viscoelastic agent. Conclusion: This study concludes that irrigating goniectomy with trabectome has good efficacy and safety in both pediatric and adult cases of glaucoma in terms of IOP control, reduction in AGMs, and low incidence of complications in the Indian population.

Predictors of Peripapillary and Macular Optical Microangiography Measurements in Healthy Eyes.

PRECIS: The vessel density (VD) and perfusion density (PD) generated by optical microangiography (OMAG) is significantly affected by the signal strength (SS). Sex, hypertension, diabetes, and axial length did not have any statistically significant effect on these measurements. PURPOSE: The aim was to assess the effect of subject-related factors (age, sex, systemic hypertension, diabetes, and axial length) and machine-related factor (SS) on VD and PD generated by OMAG in peripapillary and macular regions. METHODS: In an observational, cross-sectional study of 200 eyes of 100 healthy individuals (age: 18 to 80 y), mean and sectoral VD and PD were calculated on disc and macular scans. Effect of subject-related and machine-related factors on VD and PD parameters were evaluated using multivariate mixed effect models. RESULTS: Mean±SD peripapillary and macular VD of the study population was 18.56±1.11 and 20.59±1.85 mm-1, respectively. Mean peripapillary and macular PD was 46.43±3.22% and 37.61±3.26%, respectively. Sex, hypertension, diabetes, and axial length did not have any statistically significant effect on the OMAG measurements (P>0.05 for all associations). However, the SS had significant effect on the OMAG measurements. Mean peripapillary and macular VD on scans with SS of 10 was 1.4 and 3.79 mm-1 greater, respectively, than that on scans with SS of 7. Mean peripapillary and macular PD on scans with SS of 10 was 4.43% and 7.85% greater, respectively, than that on scans with SS of 7. CONCLUSION: Significant association exists between SS of the scan and the optical coherence tomography angiography measurements generated by OMAG even when the scans have acceptable SS as recommended by the manufacturer (≥7). This needs to be considered while interpreting optical coherence tomography angiography measurements.