Outcomes of ab interno trabeculectomy with the trabectome by degree of angle opening

Abstract

AimTo analyse ab interno trabeculectomy (AIT) with the trabectome and combined phacoemulsification with AIT (phaco-AIT) by Shaffer angle grade (SG).MethodsProspective study of AIT and phaco-AIT with narrow angles of SG≤2 versus open angles ≥3. Outcomes included intraocular pressure (IOP), medications, complications, secondary surgery and success (IOP <21 mm Hg and >20% reduction without further surgery). Exclusion criteria were missing preoperative data and <1 year follow-up.ResultsOf 671 included cases, at 1 year AIT SG≤2 (n=43) had an IOP reduction of 42% from 27.3±7.4 to 15.7±3.0 mm Hg (p<0.01) versus AIT SG≥3 (n=271) with an IOP reduction of 37% from 26.1±7.8 to 16.4±3.9 mm Hg (p<0.01). In phaco-AIT with SG≤2 (n=48), IOP was reduced 24% from 20.7±7.0 to 15.7±3.6 mm Hg (p<0.01) versus phaco-AIT with SG≥3 (n=309) with an IOP reduction of 25% from 22.6±6.4 to 17.0±3.4 mm Hg (p<0.01). There was no difference between SG≤2 and SG≥3 in reduction of IOP or medications, complications, secondary surgery and success rates (p>0.05).ConclusionsSG≤2 is not associated with worse outcomes in AIT or phaco-AIT.

Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching

“…In contrast, epibulbar glaucoma drainage implants bypass both the conventional and the uveoscleral route entirely but are subject to encapsidation that is the result of fibrosis and a chronic foreign body reaction [19]. We recently expanded our practice pattern to use AIT as a first surgery for more than mild glaucoma because our studies suggested that AIT can be used after failed trabeculectomy [10], in narrow angles [20] and for more severe glaucoma [6][7][8]. BGIs lowered IOP to a similar extend as trabeculectomies in a randomized controlled trial but had a higher success rate [14].…”

Quantification of Focal Outflow Enhancement using Differential Canalograms

“…There is ample new clinical evidence [29][30][31][32][33] that very significant outflow resistance exists downstream of the trabecular meshwork as trabecular ablation rarely achieves the theoretically lowest intraocular pressure, which would be equal to that of episcleral venous pressure according to the Goldmann equation. 1 The lack of an inexpensive, readily available, and high quality outflow model has impeded glaucoma research and training of surgery on this submillimeter structure alike.…”

Recent Developments in Glaucoma Therapy

“…In four of our recent clinical TM ablation studies with up to 1,340 patients, this post-trabecular resistance causes a higher failure rate and a higher postoperative IOP in many individuals with advanced glaucoma. [11][12][13][14] As glaucoma surgeons are well aware, only a small fraction of patients (in our hands about 0.3%) achieve the predicted IOP that would be equal to that of episcleral venous pressure.…”

“…Similar to the trabectome, the active dual blade goniectome is versatile because of the irrigation and aspiration and can be used for goniosynechiolysis in narrow or closed angles. 6,7 It can simply be plugged into any phaco machine or gravity-fed infusion system that uses a pole.…”