Ocular Biometric Predictors of Corneal Endothelial Contact by Intracameral Implants for Open-Angle Glaucoma and Ocular Hypertension.

PURPOSE

To identify biometric factors predictive of corneal endothelial contact (CEC) by intracameral implants in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHTN).

METHODS

In this prospective observational study, patients with a chart diagnosis of POAG or OHTN without prior cataract or incisional glaucoma surgery were consecutively enrolled between August 2022 and October 2023. Participants underwent anterior segment optical coherence tomography (AS-OCT) imaging along the vertical meridian under dark and light conditions. An intracameral implant was simulated by overlaying a 0.2-mm-diameter circle onto an AS-OCT image of the inferior angle recess to predict CEC, defined as implant contact anterior to Schwalbe's line. Logistic regression models were developed to identify predictors of CEC.

RESULTS

CEC was present in 14 eyes (17.9%) and 11 eyes (14.1%) from 78 eyes of 78 participants in the dark and light conditions, respectively. In univariable analysis, smaller angle opening distance (750 µm; AOD750), shallower anterior chamber depth, greater lens vault and thickness, and iridotrabecular contact were significantly associated with CEC in both environments (P < 0.05). AOD750 was the strongest predictor of CEC (dark AUC = 0.99; light AUC = 0.97), with optimal cutoffs of 0.22 mm (dark) and 0.30 mm (light). Gonioscopy grade was less predictive of CEC (dark AUC = 0.79; light AUC = 0.84).

CONCLUSIONS

CEC by a simulated intracameral implant was predicted in a subset of patients with chart diagnosis of POAG or OHTN. AS-OCT biometrics were more strongly predictive of CEC than gonioscopy.

TRANSLATIONAL RELEVANCE

AS-OCT may enhance preoperative evaluation of intracameral implant candidates by identifying those at higher risk for CEC.