Severe trench pattern scarring post-MIGS predicts need for glaucoma medications

Severe scarring in a trench pattern, as observed using anterior segment optical coherence tomography (AS-OCT), predicts the need for glaucoma medications after minimally invasive glaucoma surgery (MIGS), according to a study.

Regular monitoring of scarring responses with AS-OCT and clinical examinations is crucial for identifying patients who may require additional medication post-surgery.

The study examined 73 eyes from 67 patients, with at least 6 months of follow-up after microincisional trabeculectomy (MIT; n = 41) or gonioscopy-assisted transluminal trabeculotomy (GATT; n=32). Structural changes in the TM were evaluated using AS-OCT at 1, 3, and 6 months post-surgery, focusing on scarring severity and patterns. The study also analyzed the relationship between scarring, need for medications, and surgical outcomes using multivariate regression.

MIT and GATT significantly reduced intraocular pressure (IOP) and medication use, with a final IOP of 15±3.2 mm Hg at an average follow-up of 8±3.2 months. Mild scarring was more common in MIT, while severe scarring was more frequent in GATT (over 65% vs 31%, P < 0.001). The trench pattern of scarring was more common in GATT eyes (>50%). Severe scarring in a trench pattern predicted the need for additional IOP-controlling medications.

Reference
Rao A, Mukherjee S. Healing responses at the angle after micro-invasive glaucoma surgery-an AS-OCT study. PLoS One. 2024;19(6):e0305740. doi: 10.1371/journal.pone.0305740. PMID: 38935644; PMCID: PMC11210766.