Long-Term Results of Trabeculotomy Ab Externo

Abstract

We retrospectively reviewed the records of patients followed for over 4 years after undergoing trabeculotomy to treat primary open-angle glaucoma (POAG) to evaluate the long-term effects of the procedure on intraocular pressure (IOP) control. IOP remained below 15 mm Hg, with no need for postoperative medication in 7 (13.2%) of 53 eyes. IOP was below 15 mm Hg in an additional eight eyes (15.1%) treated with topical medication. Topical medication was needed to maintain IOP between 16 to 20 mm Hg in 23 eyes (43.4%). Oral acetazolamide or additional surgery was needed in 15 (28.3%). A postoperative IOP below 20 mm Hg with or without topical medication was associated with a survival probability of 71.2%, Our results demonstrated that, although trabeculotomy largely failed to maintain an "ideal" postoperative IOP (below 15 mm Hg), it was not associated with severe operative or postoperative complications such as flat anterior chamber. Thus, the procedure probably should be the first choice not only in uncomplicated cases of congenital glaucoma and pseudoexfoliation glaucoma (as previously established), but also in cases of POAG in young patients with only slight damage to the optic disc or visual field and cases with forward movement of the iris-lens diaphragm.

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

“…On the basis of the mechanisms underlying increased IOP in UG, trabeculotomy is an appropriate surgical procedure for UG. In addition, trabeculotomy has a lower rate of postoperative complications (eg, corneal epithelial damage, bleb leakage, hypotony, flat anterior chamber, and serous choroidal detachment) compared with trabeculectomy (TLE) with mitomycin C 8–11…”

“…6,7 On the basis of the mechanisms underlying increased IOP in UG, trabeculotomy is an appropriate surgical procedure for UG. In addition, trabeculotomy has a lower rate of postoperative complications (eg, corneal epithelial damage, bleb leakage, hypotony, flat anterior chamber, and serous choroidal detachment) compared with trabeculectomy (TLE) with mitomycin C. [8][9][10][11] We previously assessed the short-term outcomes of modified 360-degree suture trabeculotomy (S-LOT) for primary open angle glaucoma (POAG) and UG. 12,13 In conventional trabeculotomy, metal trabeculotomes are applied to a 120-degree incision in the Schlemm canal, whereas the 360-degree suture trabeculotomy technique opens the entire circumference of the Schlemm canal in a single surgical procedure.…”

Reduction of Intraocular Pressure and Aqueous Outflow Resistance After Modified 360-degree Suture Trabeculotomy

“…Harms subsequently modified the technique in 1970, employing a scleral flap to more easily identify Schlemm's canal, which further popularized the surgery. 3 The goal of trabeculotomy is to reduce intraocular pressure (IOP) in patients with glaucoma by relieving the resistance of aqueous humor outflow. Numerous studies demonstrated the efficacy of trabeculotomy in reducing the IOP without bleb formation.…”

“…Trabeculotomy is an outflow channel surgery first reported by Burian1 and Smith2 in 1960. Harms subsequently modified the technique in 1970, employing a scleral flap to more easily identify Schlemm’s canal, which further popularized the surgery 3…”

“…The goal of trabeculotomy is to reduce intraocular pressure (IOP) in patients with glaucoma by relieving the resistance of aqueous humor outflow. Numerous studies demonstrated the efficacy of trabeculotomy in reducing the IOP without bleb formation 1–10. As trabeculotomy does not result in bleb formation, postoperative complications, such as bleb leaks, hypotony, flat anterior chambers, and serous choroidal detachment, which are associated with trabeculectomy, develop less frequently than after filtering surgery (trabeculectomy) 2,3…”