Histologic Analysis of Trabecular Meshwork Obtained From Kahook Dual Blade Goniotomy.
Swarup S Swaminathan, Pedro Monsalve, Xiao Yi Zhou, Mabel Enriquez-Algeciras, Sanjoy K Bhattacharya, Sander R Dubovy, Anna K Junk
Summary
This pilot study demonstrates that tissue obtained during KDB goniotomy has a high yield of containing TM compared to reported yield of TM in specimens collected from traditional ab externo trabeculectomy (71% vs 20%, respectively).
Abstract
PURPOSE
To determine whether there are identifiable, reproducible findings in the trabecular meshwork (TM) of patients with primary open-angle glaucoma (POAG) who underwent Kahook Dual Blade (KDB) goniotomy.
DESIGN
Noncomparative retrospective case series.
METHODS
Tertiary academic referral center, Veterans Affairs Medical Center. Thirteen patients (14 eyes) with POAG (100%) were treated with KDB goniotomy from May to December 2017. Isolated TM tissue was collected from 9 patients (10 eyes) and submitted for histologic analysis. Hematoxylin-eosin, periodic acid-Schiff, and elastin Van Gieson stains were completed, in addition to immunohistochemistry for collagen IV.
RESULTS
Mean age of patients was 74.2 ± 6.7 years. Trabecular beams were identified in all 10 specimens, although distorted in 4 samples, of which 3 had a history of laser trabeculoplasty. Collagen IV staining was present in 10 of 10 samples, coating the trabecular beams. Elastin was present in 8 of 10 samples along the trabecular beams. Intraocular pressure and number of glaucoma medications decreased significantly in all cases postoperatively (P < .0001, P = .035, respectively).
CONCLUSIONS
This pilot study demonstrates that tissue obtained during KDB goniotomy has a high yield of containing TM compared to reported yield of TM in specimens collected from traditional ab externo trabeculectomy (71% vs 20%, respectively). These goniotomy specimens possess sufficient anatomic preservation to be studied histologically. Trabecular meshwork obtained with this procedure may provide a novel modality to study TM dysfunction in open-angle glaucomas.
More by Swarup S Swaminathan
View full profile →Rapid initial OCT RNFL thinning is predictive of faster visual field loss during extended follow-up in glaucoma.
Predictors of Neovascular Glaucoma in Central Retinal Vein Occlusion.
Rates of Glaucoma Progression Derived from Linear Mixed Models Using Varied Random Effect Distributions.
Top Research in Glaucoma Surgery
Browse all →Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 1 Year of Follow-up.
Efficacy, Safety, and Risk Factors for Failure of Standalone Ab Interno Gelatin Microstent Implantation versus Standalone Trabeculectomy.
Prospective, Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract: Two-Year Results.
Discussion
Comments and discussion will appear here in a future update.