Clinical results of ab interno trabeculotomy using the trabectome in patients with uveitic glaucoma

Abstract

Importance: To evaluate the safety and efficacy of ab interno trabeculotomy (AIT) (trabecular ablation) with the trabectome in patients with uveitic glaucoma. Background: Traditional glaucoma filtration surgeries in the uveitic patient population come with a higher risk of complications such as failure and hypotony. Design: Retrospective observational cohort study.Participants: All patients diagnosed with uveitic glaucoma were included in this study. Patients were excluded if they have less than 12 months of follow-up. Methods: All patients who received AIT alone or combined with phacoemulsification. Main Outcome Measures: Major outcomes include intraocular pressure (IOP), number of glaucoma medications and secondary glaucoma surgery, if any. Kaplan-Meier method was used for survival analysis and success was defined as IOP ≤21 mmHg, at least 20% IOP reduction from baseline for any two consecutive visits after 3 months, no additional glaucoma medications, and no secondary glaucoma surgery. Results: A total of 45 eyes, 45 patients, with an average age of 52 years were included in the study. The majority were Japanese (40%) and underwent AIT alone (71%). IOP was reduced from 29.2 ± 8.0 to 16.7 ± 4.6 mmHg at 12 months (P < .01*), while the number of glaucoma medications was reduced from 4.0 ± 1.0 to 2.5 ± 1.6 (P < .01*). Survival rate at 12 months was 91%. Six cases required secondary glaucoma surgery and no other serious complication were reported. Conclusions and Relevance: The trabectome AIT procedure appears to be effective in reducing IOP in uveitic glaucoma patients. Although no statistically significant difference was found in the number of glaucoma medications, a decreasing trend was found. K E Y W O R D Sab interno trabeculotomy, glaucoma treatment, trabectome, uveitis

Long-term Outcomes of Modified 360-degree Suture Trabeculotomy for Uveitic Glaucoma Compared with Primary Open Angle Glaucoma

“…17 Another study showed a success rate of 91% ( ≤ 21 mm Hg) for Trabecutome in UG after 1 year. 18 Furthermore, a success rate of 81.8% ( ≤ 21 mm Hg) for trabeculotomy in pediatric UG was achieved with a mean follow-up of 33.6 months. 19 In contrast, the success rates of trabeculotomy were 45% in chronic UG ( ≤ 21 mm Hg) after 3 years, 20 and 40% ( ≤ 21 mm Hg) in UG after 4 years.…”

“…Success rates of 62.5% (<20 mm Hg) for trabeculotomy and 75.0% for Trabecutome in UG were previously reported with a mean follow-up of 40.32 months 17. Another study showed a success rate of 91% (≤21 mm Hg) for Trabecutome in UG after 1 year 18. Furthermore, a success rate of 81.8% (≤21 mm Hg) for trabeculotomy in pediatric UG was achieved with a mean follow-up of 33.6 months 19.…”

“…Previous studies investigated the outcomes of trabeculotomy (including Trabecutome, S-LOT, and conventional trabeculotomy with metal trabeculotomes) in UG patients 13,17–20. However, they had small sample sizes and short observation periods, including our studies.…”

“…Previous studies investigated the outcomes of trabeculotomy (including Trabecutome, S-LOT, and conventional trabeculotomy with metal trabeculotomes) in UG patients. 13,[17][18][19][20] However, they had small sample sizes and short observation periods, including our studies. Therefore, the aims of the present study were to examine and compare the outcomes of S-LOT for UG and POAG, and identify risk factors for long-term surgical failure in a relatively large population sample.…”

Ab interno trabeculotomy in uveitic glaucoma: Confirmation of original results with extended applications

“…Interestingly, the results of the study by Swamy et al in this issue of CEO mirror those early findings almost exactly. This study was performed on patients with uveitic glaucoma and the IOP at 12‐month follow‐up was 16.7 mmHg, reduced from a baseline of 29.2 mmHg . In the years between that first study and the current one, dozens of papers have been published on ab interno trabeculotomy in various subtypes and severities of glaucoma, by hundreds of investigators, and from all corners of the globe …”