The association between corneal hysteresis and surgical outcomes from trabecular meshwork microinvasive glaucoma surgery
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GLAUCOMA
The association between corneal hysteresis and surgical outcomes from trabecular meshwork microinvasive glaucoma surgery Nathaniel Tracer 1
&
Samantha Ayoub 2 & Nathan M. Radcliffe 2,3
Received: 2 December 2019 / Revised: 4 August 2020 / Accepted: 5 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess whether an association exists between pretreatment corneal hysteresis (CH) and the magnitude of intraocular pressure (IOP) and medication burden reduction following microinvasive glaucoma surgery (MIGS). Methods Retrospective chart review of 84 eyes from 57 patients with CH measurements who underwent trabecular meshwork MIGS in a glaucoma practice in New York City with follow-up visits at 3–6 and 9–12 months. MIGS included canaloplasty, goniotomy, microbypass stents, or a combination thereof. Results The lowest and middle CH tertiles experienced significantly reduced mean IOP at 3–6-month follow-ups (p = .007, < .001), whereas the highest tertile did not (p = .06). At 9–12-month follow-ups, a significant mean IOP reduction only persisted in the middle tertile (p = .001). For medication burden reduction, only the highest CH tertile experienced significant mean reductions at both 3–6- and 9–12-month follow-ups (p = .015, .028). Notably, 7 patients in the lowest CH tertile failed MIGS and required an additional surgical or laser procedure within 24 months of MIGS, whereas only 3 patients failed in the other tertiles (likelihood ratio < .05). Multivariate analysis excluding MIGS failures demonstrated an inverse association between CH and the magnitude of post-operative IOP reduction at both 3–6- and 9–12-month follow-ups when controlling for baseline IOP and medication changes (p = .002, .026). Conclusion There was an inverse association between pretreatment CH and the magnitude of IOP reduction following surgery. There is also evidence of an increased need for repeat surgery or other intervention in patients with lower CH who undergo MIGS. Keywords Glaucoma . Corneal hysteresis . Microinvasive glaucoma surgery . Central corneal thickness . Intraocular pressure
Introduction Glaucoma is the leading cause of irreversible blindness worldwide with an estimated prevalence of 3.54% of those aged 40– 80. Globally, the number of people aged 40–80 estimated to have glaucoma was 64.3 million in 2013 and is projected to reach 76 million by 2020 [1]. Known risk factors for glaucoma include older age, lower central corneal thickness (CCT), elevated intraocular pressure (IOP), African-American race, and Hispanic ethnicity [2, 3]. Corneal hysteresis has recently * Nathaniel Tracer [email protected] 1
New York University School of Medicine, New York, NY, USA
2
Mount Sinai Health System, New York, NY, USA
3
New York Eye Surgery Center, New York, NY, USA
been demonstrated in several prospective studies to be a stronger risk factor for glaucoma development and progression than corneal thickness [4–6]. Since IOP is currently the only known modifiable risk factor, treatme
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