Comparison of the short-term results of nasal and temporal 180° selective laser trabeculoplasties for open-angle glaucoma

ABSTRACT Purpose: The nasal sector of the anterior chamber angle may present a higher density of collector channels, which may influence the results of angle surgeries. Considering the anatomical differences in the anterior chamber angle, we compared the results of the nasal and temporal 180° selective laser trabeculoplasty approaches for open-angle glaucoma. Methods: A retrospective chart review was conducted for patients with open-angle glaucoma (primary, pseudoexfoliation, and pigmentary) who underwent at least one 180° selective laser trabeculoplasty session between December 2016 and October 2018. The nasal (N1) or temporal (T1) sectors were chosen at the physician’s discretion. Patients who did not experience decreased intraocular pressure between 3 and 6 months again underwent 180° selective laser trabeculoplasty in the opposite angle sector (T2 and N2). The main outcome measured was decrease in intraocular pressure at 6-month follow-up, after the last selective laser trabeculoplasty. A multivariable regression analysis was used to evaluate factors associated with decreased intraocular pressure after treatment. Results: The procedure was performed initially in 45 eyes (N1, 25; T1, 20 eyes) and repeated in the opposite anterior chamber angle sector in 19 eyes (N2, 11; T2, 8 eyes). Analysis of variance revealed that only the N1 approach presented a significant difference in the decrease in intraocular pressure as compared with the T1, N2, and T2 approaches (p=0.0014). The baseline intraocular pressure (p=0.021) and anterior chamber angle sector (N1; p=0.044) correlated with decreased intraocular pressure. Conclusion: Compared with the temporal approach, 180° selective laser trabeculoplasty performed initially in the nasal sector was associated with a more significant decrease in intraocular pressure. Considering the sectorial differences in the anterior chamber angle, further prospective trials are warranted to confirm our findings and provide more-efficient selective laser trabeculoplasty protocols.

摘要 目的：前房角（anterior chamber angle）鼻侧象限的集液管（collector channels）密度可能更高，这可能会影响房角手术的疗效。鉴于前房角存在解剖学差异，本研究对比了开角型青光眼（open-angle glaucoma）患者接受鼻侧与颞侧180°选择性激光小梁成形术（selective laser trabeculoplasty）的治疗效果。方法：本研究为回顾性病历回顾分析，纳入2016年12月至2018年10月期间接受过至少1次180°选择性激光小梁成形术的开角型青光眼患者，包括原发性、假性剥脱性和色素性开角型青光眼。手术时由医师自行选择鼻侧（N1）或颞侧（T1）象限进行操作。若患者在术后3~6个月未出现眼压（intraocular pressure, IOP）下降，则在对侧房角象限再次行180°选择性激光小梁成形术（对应T2和N2组）。本研究的主要结局指标为末次选择性激光小梁成形术后6个月随访时的眼压下降幅度。采用多变量回归分析评估治疗后眼压下降相关的影响因素。结果：本研究初始共对45只眼实施手术（N1组25只，T1组20只），其中19只眼因疗效不佳在对侧前房角象限接受了二次手术（N2组11只，T2组8只）。方差分析结果显示，仅N1组的眼压下降幅度与T1、N2及T2组相比存在显著统计学差异（p=0.0014）。基线眼压（p=0.021）与前房角象限类型（N1组；p=0.044）与眼压下降幅度存在相关性。结论：与颞侧手术入路相比，初始采用鼻侧象限行180°选择性激光小梁成形术可带来更显著的眼压下降。鉴于前房角存在象限解剖差异，未来需开展前瞻性临床试验以验证本研究结果，并优化更高效的选择性激光小梁成形术方案。