Department of Ophthalmology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA.
Arq Bras Oftalmol. 2023 May-Jun;86(3):217-222. doi: 10.5935/0004-2749.20230044.
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.
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.
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.
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.
前房角的鼻侧区域可能具有更高密度的集合管，这可能会影响角度手术的结果。考虑到前房角的解剖差异，我们比较了鼻侧和颞侧 180°选择性激光小梁成形术治疗开角型青光眼的结果。
对 2016 年 12 月至 2018 年 10 月期间至少接受一次 180°选择性激光小梁成形术的开角型青光眼（原发性、假性剥脱和色素性）患者进行回顾性图表审查。鼻侧（N1）或颞侧（T1）区域由医生选择。在 3 至 6 个月之间未经历眼压降低的患者再次在相反的角度区域（T2 和 N2）接受 180°选择性激光小梁成形术。主要观察指标是最后一次选择性激光小梁成形术后 6 个月时眼压的降低。采用多变量回归分析评估治疗后眼压降低相关的因素。
该程序最初在 45 只眼中进行（N1，25 只；T1，20 只），在 19 只眼中重复进行了相反的前房角区域（N2，11 只；T2，8 只）。方差分析显示，只有 N1 方法在眼压降低方面与 T1、N2 和 T2 方法相比具有显著差异（p=0.0014）。眼压基线（p=0.021）和前房角区域（N1；p=0.044）与眼压降低相关。
与颞侧方法相比，最初在鼻侧进行的 180°选择性激光小梁成形术与眼压降低更显著相关。考虑到前房角的扇形差异，需要进一步的前瞻性试验来证实我们的发现，并提供更有效的选择性激光小梁成形术方案。
