The drainage angle in the anterior chamber of the eye mediates the outflow of aqueous humor, and pathological changes here can lead to high intraocular pressure and glaucoma. Minimally invasive glaucoma surgery, particularly angle surgery, has advanced recently, allowing clear visualization of angle structures like the trabecular meshwork and Schlemm's canal using surgical goniolens. Techniques for angle intervention include widening the angle, reopening closed angles, and rebuilding outflow pathways using methods such as laser peripheral iridotomy, Argon laser peripheral iridoplasty, and mechanical separation of adhered tissues. Our research team plans to conduct imaging studies to track the healing of angle tissues post-surgery, aiming to support innovation and standardization of minimally invasive angle surgery.
Glaucoma patients eligible for standalone or combined angle intervention surgeries, such as LPI, LPIP, goniosynechialysis, trabeculotomy alone or combined with surgical iridectomy or phacoemulsification and intraocular lens implantation;
Patients capable of undergoing preoperative examinations including CASIA2-OCT (anterior segment OCT), UBM, slit-lamp gonioscopy, IOL Master (or other optical biometry);
Patients willing to participate in this study, signing informed consent, and agreeing to follow-up according to the study protocol.
Patients with severe ocular conditions such as corneal infection, ulcer, trauma, ocular tumors, retinal vascular occlusion, and retinal detachment;
Those with various types of eye diseases that affect ocular parameter acquisition or interfere with visual field examination;
Long-term local or systemic use of glucocorticoids;
Patients with severe systemic diseases;
Patients diagnosed with glaucoma typically present with: IOP \> 21 mmHg with or without the use of ocular hypotensive medications; (3) with obvious glaucomatous optic neuropathy \[cup-to-disc (C/D) ratio ≥ 0.7, C/D ratio asymmetry \> 0.2, or rim width at the superotemporal and inferotemporal \< 0.1 vertical diameter of the optic disc\], and glaucomatous visual field defects, such as nasal step, arcuate scotoma, and paracentral scotoma;
Cohort
Prospective
various types of angle interventions
Procedure/Surgeryprocedures include laser peripheral iridotomy (LPI) to relieve pupillary tissue and deepen peripheral anterior chamber depth, Argon laser peripheral iridoplasty (ALPIp) to stimulate iris contraction and widen the angle, and mechanical separation of adhered angle tissues using instruments like goniosynechialysis hooks or iris repositor. Ab interno goniotomy using instruments like retina hooks, trabeculectomy hooks, or cannulas are used to incise trabecular meshwork and Schlemm's canal walls to enhance aqueous humor outflow.
Changes in biological parameters of the anterior chamber angle
Biological parameter changes in the anterior chamber following angle intervention surgery will be measured using Casia2-OCT
success rate of angle intervention surgeries
complete success was defined as postoperative IOP within the range of 6-18 mmHg, and a reduction of 20% from baseline without loss of light perception, additional ocular hypotensive medication, and reoperation. The definition of qualified success was similar to that of complete success, except for the need for ocular hypotensive medications. Postoperative ocular hypotensive medications were adjusted according to the IOP at each visit.
safety of angle intervention surgeries
The main observation includes recording intraoperative and postoperative complications, including hyphema, choroidal detachment, cyclodialysis, persistent hypotony, corneal decompensation, and intraocular inflammation.
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