Aqueous Angiographic Outflow Improvement after Trabecular Microbypass in Glaucoma Patients

Purpose: To study changes in aqueous humor outflow (AHO) patterns after trabecular microbypass (TMB) in glaucoma patients using intraoperative sequential aqueous angiography. Design: Prospective, comparative case series. Participants: Fifteen participants (14 with glaucoma and 1 without glaucoma). Methods: Sequential aqueous angiography (Spectralis HRA+OCT; Heidelberg Engineering) was performed on 14 glaucoma patients undergoing routine TMB (iStent Inject; Glaukos Corporation) and cataract surgery and 1 patient undergoing cataract surgery alone. Indocyanine green (ICG) aqueous angiography established initial baseline nasal angiographic AHO patterns. Two TMB stents were placed in regions of baseline low or high angiographic AHO in each eye (n = 2 eyes with enough space to place 2 stents in both low angiographic regions; n = 8 eyes with 2 stents both placed in high angiographic regions; n = 4 eyes with enough space to place 1 stent in a low angiographic region and the other stent in a high angiographic region). Subsequent fluorescein aqueous angiography was used to query alterations to angiographic AHO patterns. Main Outcome Measures: Angiographic signal and patterns before and after TMB. Results: At baseline, all eyes showed segmental angiographic AHO patterns. Focused on the nasal hemisphere of each eye, for each stent, TMB in initially low ICG angiographic signal regions showed transient or persistently improved fluorescein angiographic signal (11.2-fold; P = 0.014). Trabecular microbypass in initially high indocyanine green angiography signal regions led to faster development of fluorescein angiographic patterns (3.1-fold; P = 0.02). Conclusions: Trabecular microbypass resulted in different patterns of aqueous angiographic AHO improvement whose further understanding may advance basic knowledge of AHO and possibly enhance intraocular pressure reduction after glaucoma surgery in the future. (C) 2018 by the American Academy of Ophthalmology