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Abstract #95436 Published in IGR 22-2
In vivo imaging of the Schlemm's Canal and the response to Selective laser trabeculoplasty
Varshney T; Azmira K; Gupta S; Mahalingam K; Singh A; Angmo D; Gupta VAmerican Journal of Ophthalmology 2022; 234: 126-137
OBJECTIVE: To evaluate the presence of angle dysgenesis on ASOCT (ADoA) as a predictive factor in determining outcomes of selective laser trabeculoplasty (SLT). DESIGN: A prospective clinical cohort study. SUBJECTS: Patients with Juvenile onset open-angle glaucoma (JOAG) without angle dysgenesis on gonioscopy (ADoG). METHOD: JOAG patients with uncontrolled IOP, who were to undergo SLT, were evaluated for the presence or absence of ADoA, which was defined as the absence of Schlemm's canal (SC) and/or presence of hyper-reflective membrane (HM) over TM as identified on ASOCT before the SLT procedure. Further, the number of ASOCT B-scans in which SC was identified as present, were then quantified. Success of SLT was defined as a reduction of IOP by 20% or more from pre-laser value at 6-months follow-up without any further IOP-lowering medication or surgery. Only one repeat SLT was admissible for defining SLT success over the 6-month period. A successful reduction in IOP at six-month follow-up was correlated with the extent of ADoA. RESULTS: In comparison to pre-SLT IOP, 57.1% (20/35) eyes showed more than 20% reduction in IOP at six months with a mean reduction of 7.6±1.8mmHg (29.6%). When all three observers agreed, SC was identified in 80% (18/20) eyes with success vs 26.6% (4/15) eyes with failure (p < 0.001). All (5/5) eyes with presence of HM showed failure (p < 0.001). All eyes (19/19) in which SC was present in >50% ASOCT B-scans (>25/50 scans/eye) showed success (p < 0.001). On a bias reduced regression analysis, the identification of SC on any two consecutive scans increased the chances of success at 6months by 8.3 times, while the identification of SC in >50% of ASOCT scans was associated with a 21.4 times greater chance of success. CONCLUSIONS: The presence of SC on ASOCT is a strong predictor for successful IOP reduction after SLT in JOAG eyes.
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India 110029.
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