Effect of postoperative corticosteroids on surgical outcome and aqueous autotaxin following combined cataract and microhook ab interno trabeculotomy

Megumi Honjo,Makoto Aihara,Nozomi Igarashi,Makoto Kurano,Koji Igarashi,Yutaka Yatomi,Reiko Yamagishi,Chui Yong Ku

doi:10.1038/s41598-020-80736-w

Megumi Honjo, Makoto Aihara + Show 6 more

Open Access

https://doi.org/10.1038/s41598-020-80736-w

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Abstract

To evaluate the effect of postoperative corticosteroids on surgical outcome and autotaxin (ATX) levels after microhook ab interno trabeculotomy combined with cataract surgery (μLOT-CS), prospective, consecutive non-randomized case series comparing outcomes of 30 eyes with primary open angle glaucoma was performed. The aqueous ATX, intraocular pressure (IOP) and glaucoma medications were monitored for 3 months postoperatively. An in-vivo mouse μLOT model was generated. In vitro, ATX and fibrotic changes induced by dexamethasone (Dex) treatment following scratch (S) in cultured human trabecular meshwork (hTM) cells were assessed by immunofluorescence, immunoenzymatic assay, and RT-qPCR. Postoperative ATX at 1 week and the number of antiglaucoma medications at 3 months were significantly lower in non-steroid group, and steroid use was the only variable significantly associated with postoperative medications at 3 months in multiregression analyses. In vitro, ATX activity was significantly upregulated in the Dex + S group, and αSMA was significantly upregulated in the Dex and Dex + S groups. Fibronectin and COL1A1 were significantly upregulated in the S group. μLOT-CS decreased IOP and medications in the overall cohort, and non-use of postoperative steroids resulted in a smaller number of postoperative medications. Limiting postoperative steroids in μLOT may minimize IOP elevation and postoperative fibrosis.

Highlights

To evaluate the effect of postoperative corticosteroids on surgical outcome and autotaxin (ATX) levels after microhook ab interno trabeculotomy combined with cataract surgery, prospective, consecutive non-randomized case series comparing outcomes of 30 eyes with primary open angle glaucoma was performed
Salimi et al compared the surgical outcome of iStent, one of the minimally invasive glaucoma surgery (MIGS) for ab-interno LOT, combined with cataract surgery with versus without postoperative topical corticosteroid therapy (TCT); they found no significant difference with respect to postoperative inflammation or peripheral anterior synechiae (PAS) formation; the steroid group had a higher number of intraocular pressure (IOP) spikes compared with the non-steroid group[25]
We previously reported that the aqueous level of autotaxin (ATX), an enzyme involved in the generation of lysophosphatidic acid (LPA) via lysoPLD activity, is upregulated in open angle glaucoma (OAG) and plays a crucial role in the regulation of trabecular meshwork (TM) fibrosis and aqueous outflow r esistance[6, 26]

Summary

Introduction

To evaluate the effect of postoperative corticosteroids on surgical outcome and autotaxin (ATX) levels after microhook ab interno trabeculotomy combined with cataract surgery (μLOT-CS), prospective, consecutive non-randomized case series comparing outcomes of 30 eyes with primary open angle glaucoma was performed. Intraocular pressure (IOP) elevation is hypothesized to result from increased aqueous humor (AH) outflow resistance, mainly in the conventional outflow pathway[1,2,3] This resistance involves the trabecular meshwork (TM) and Schlemm’s canal (SC) tissues in cases of primary open angle glaucoma (POAG), which is the most common form of g laucoma[4]. Salimi et al compared the surgical outcome of iStent, one of the MIGS for ab-interno LOT, combined with cataract surgery (iStent-CS) with versus without postoperative TCT; they found no significant difference with respect to postoperative inflammation or peripheral anterior synechiae (PAS) formation; the steroid group had a higher number of IOP spikes compared with the non-steroid group[25]

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