Discussion
humour, glaucoma, Flare
INFLAMMATION, GLAUCOMA
The purpose of the present study was to compare postoperative incisional cross-sectional area between KDB goniotomy and ab interno trabeculotomy with the microhook. The measurement using AS-OCT found a significantly larger incisional cross-sectional area in TM in the KDB group than in the microhook group throughout the postoperative follow-up visits (Several reports have focused on anterior chamber imaging after MIGS, the target for TM, including the anterior chamber parameter after trabectomeSubgroup analyses showed incisional cross-sectional areas in some patients appeared to be occluded immediately after the ab interno trabeculotomy with the microhook, and the number of patients continued to increase and was significantly higher than KDB goniotomy thereafter. No patients experienced obstruction immediately after KDB goniotomy; however, patients with occlusion gradually increased during follow-up visits. Only a few studies have been conducted on histological changes in TM after trabeculotomy using an animal modelDespite the significant difference in incisional cross-sectional area between the two groups, none of the rate of IOP changes, numbers of postoperative glaucoma medications and the usage rate per glaucoma medication type were found to show significant differences between the two groups. Postoperative IOPs of the two surgical procedures in our study are consistent with the IOP data in previous studiesThis study showed that flare values were significantly higher in the KDB group at 12 months postoperatively. In general, the inflammatory phase is an essential process during wound healingGlaucoma medications, particularly prostaglandin and ripasudil, were related to inflammation. Prostaglandin can induce inflammationNo significant differences were also observed in postoperative corneal ECDs between the two groups. Because the intra-operative incision site is close to the corneal endothelium, the tip structure of KDB might be associated with a higher risk of contracting the corneal endothelium intra-operatively. However, the difference in the tip width between the two MIGS devices does not contribute to the loss of corneal ECDs.This study has some limitations. This study included both patients with and without stable IOP control. The results may differ if the trial was performed only on patients with uncontrolled IOP control. The capacity of the AS-OCT is limited to capture the size. Image-J was also used as an adjunct to evaluate the incisional cross-sectional area, although completely confirming how the TM is repaired is impossible. An evaluation using electron microscopy and a histological demonstration are required to determine the TM repair process in more detail. Flare values do not indicate all inflammatory factors in the anterior chamber. Since the laser flare metre measures the protein concentration, another experimental procedure such as an enzyme-linked immunosorbent assay would help evaluate the changes of cytokines and other protein molecules in the aqueous humour.In conclusion, the incisional cross-sectional area was larger in the KDB group for all periods than in the microhook group, although no time points for the significance in the rate of IOP changes were observed between the two groups. The microhook group had the higher number of patients with TM-obstructed cross-sectional area observed by AS-OCT postoperatively. Therefore, TM repair may be less likely completed in patients with larger incisional sizes.