CHANGE IN ANTERIOR CHAMBER INFLAMMATION AFTER GONIOSCOPY-ASSISTED TRANSLUMINAL TRABECULOTOMY: LASER FLARE METER STUDY

To quantitatively evaluate anterior chamber inflammation using a flare meter after gonioscopy-assisted transluminal trabeculotomy (GATT), one of the minimally invasive glaucoma surgery options.

Beyoglu Eye Training and Research Hospital

For the cross-sectional study, patients who underwent GATT between January-April 2023 were examined. Best-corrected visual acuity, intraocular pressure (IOP), and the number of antiglaucomatous molecule used were evaluated preoperatively, on the 1st postoperative day, in the 2nd week, 1st month, 3rd month, and in the 6th month. At each visit, inflammation in the anterior chamber was measured with a laser flare meter (Kowa FM 700, Kowa Company Ltd, Japan).

Thirty eyes of 30 patients were analyzed. Mean age was 67.2±12.9 years. Fourteen eyes had primary open-angle glaucoma (POAG), and 16 eyes had pseudoexfoliation glaucoma (PEG). Seventeen of the eyes were phakic and 13 were pseudophakic. The mean preoperative visual acuity was 0.65±0.68 logMAR and did not change significantly (p>0.05). The mean preoperative IOP was 26.7±6.1 mmHg, and it decreased significantly in the postoperative visits (13.8±4.4, 13.9±3.1, 12.4±2.5 mmHg, in the postoperative 1st, 3rd and 6th months, respectively) (p<0.001). Each patient was using a topical prostaglandin analogue preoperatively. The mean number of antiglaucomatous molecule was 3.92±0.86 preoperatively and it significantly decreased after surgery (in the postoperative 1st, 3rd and 6th months 0.84±1.18, 1.04±1.24, 1.72±2.56, respectively) (p<0.001). The mean anterior chamber flare was 11.80±6.04 ph/ms before surgery, and it increased significantly to 36.30±12.15 ph/ms in the 2nd week (p=0.002). Although the anterior chamber flare gradually decreased after surgery (in the postoperative 1st, 3rd and 6th months 19.90±3.65, 17.11±3.42 and 22.49±6.39 ph/ms, respectively), it was still higher than the preoperative period. However, this difference lost its significance as of the 3rd month (p>0.05). The flare at each visit was higher in PEG patients than in POAG, but the difference was not significant (p>0.05). Postoperatively, hyphema and fibrin were observed in 17 and 3 patients, respectively. The fibrin and hyphema regressed in an average of 2 and 4 days, respectively. At the last visit, peripheral anterior synechiae (PAS) in the iridocorneal angle were observed at an average of 3.6 clock dial in those with PEG and at 2.1 in those with POAG, although the difference was not significant (p>0.05). There was a positive correlation between the number of clock dials that developed PAS at the last visit and the flare in the 2nd week (p=0.04, r=0.37).

Inflammation in the anterior chamber increases significantly in the early postoperative period after GATT and even in the sixth postoperative month, it remains higher. Control and follow-up of inflammation in the anterior chamber may be important for the evaluation of changes occurring in the angle after GATT and the sustainability of surgical success.