Search

Purpose: To report the early postoperative causes of intraocular pressure (IOP) spikes after complete circumferential gonioscopy-assisted transluminal trabeculotomy (GATT) using anterior segment optical coherence tomography (ASOCT). Methods: This was retrospective interventional case series of patients who underwent circumferential GATT by a single surgeon (APR) from 2021 to 2022 at a tertiary eye care in East India and who developed IOP spikes at 1 day-2 weeks (immediate) or early (> 2 weeks– 2 months) after GATT. The intraocular pressure (IOP), glaucoma medications, and angle evaluation by ASOCT at 1 week, and 1 month were compared between the two groups. Results: Thirty-two eyes of 32 consecutive patients, aged 40± 20.1 years (20 exfoliation glaucoma, 9 juvenile open-angle, and 3 developmental glaucoma), that developed IOP spikes between immediate (n=20) or early (n=12) IOP spikes after GATT, were included. Immediate postoperative spikes were seen in 20 eyes due to retained viscoelastic (n=8), hyphema (n=8) in uncontrolled hypertension, and peripheral anterior synechiae (PAS) (n=6) of which only one eye required medication at 2 months. Causes of immediate IOP spikes on ASOCT included an inverted/reattached trabecular shelf, iris strands in eyes with abnormal iris in developmental glaucoma, and PAS in 1– 2 quadrants. Causes of early IOP spikes included PAS > 3 quadrants (n=8), and hyperreflective fibrotic tissue over TM (n=4) with 50% requiring medications at 2 months. The ASOCT features predicting the need for medications were PAS > 3 quadrants (OR=8.4[2.2– 14.3], p=0.03) and fibrotic TM closure (OR=5.4, [3.6– 10.2], p=0.003). One eye with macrohyphema 3 days after surgery owing to uncontrolled hypertension (owing to the stoppage of medicines), required additional incisional trabeculectomy within 1 month of surgery. Conclusion: Immediate IOP spikes are mostly self-resolving as opposed to early IOP spikes > 2 weeks that require medications after GATT. Gonioscopic PAS > 3 quadrants, and fibrotic TM closure were the main identifiable ASOCT causes predicting the need for medications after GATT. [ABSTRACT FROM AUTHOR]

This article reports proximal lacrimal system parameters using Anterior Segment Optical Coherence Tomography (ASOCT-Visante) in an apparently normal Asian Indian population with assessment of any correlation between tear meniscus height and punctal diameter. This was a prospectively designed observational study that included healthy adults, who volunteered for optical coherence tomography imaging (OCT) of their proximal lacrimal system. Time domain ASOCT (Visante) images of the punctum and proximal canaliculus were captured using the high resolution corneal scan protocol. External lacrimal punctal diameter (ELP), internal lacrimal punctal diameter (ILP), vertical canalicular length (VCL) and tear meniscus height (TMH) were calculated. Statistical analysis was performed using Pearson's correlation test. Our study had 100 normal subjects with mean age 24.14 years, range 15-38 years. ASOCT (Visante) with advantage of deeper penetration was able to image canaliculus in all cases. The mean TMH, ELP, ILP and VCL was 252.7 ± 67.98 μm, 382.2 ± 103.14μm, 140.7 ± 67.29 μm and 811.8 ± 253.7 μm, respectively, in 100 normal subjects. No correlation was found between ELP, ILP and TMH (Pearson's Correlation; r = -0.355, p > 0.05 for all). ASOCT (Visante TM ) is a non-invasive and easy to use objective tool for imaging proximal lacrimal system. Further studies are required to validate normative data and correlate with microscopic findings of lacrimal system.