Review and meta-analysis of ab-interno trabeculectomy outcomes

Kaplowitz, Kevin; Bussel, Igor I.; Honkanen, Robert; Schuman, Joel S.; Loewen, Nils A.

doi:10.1136/bjophthalmol-2015-307131

Cited by 178 publications

(145 citation statements)

References 39 publications

(57 reference statements)

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“…Ab interno trabeculectomy with the trabectome, a plasma surgical modality that ionizes and aspirates the trabecular meshwork with minimal energy transfer to surrounding tissues, was first introduced in 2004 4 and is considered a more mature microincisional glaucoma surgery. Trabectome surgery, similar to other surgeries in this family, has a favorable safety profile 5 but is often only performed in ocular hypertension or mild glaucoma stages 6 .…”

Section: Introductionmentioning

confidence: 99%

Combined analysis of trabectome and phaco-trabectome outcomes by glaucoma severity

et al. 2016

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Prior glaucoma severity staging systems were mostly concerned with visual field function and retinal nerve fiber layer, but did not include intraocular pressure or medications to capture resistance to treatment. We recently introduced a simple index that combines pressure, medications, and visual field damage and applied it to stratify outcomes of trabectome surgery. This microincisional glaucoma surgery removes the primary resistance to outflow in glaucoma, the trabecular meshwork, and has been mostly used in mild glaucoma. Traditional glaucoma surgeries have a relatively high complication rate and have been reserved for more advanced disease stages. In the analysis presented here we include our data of trabectome combined with cataract surgery. This is a common practice pattern as both occur in the same age group with increasing frequency. For patients in higher glaucoma index (GI) groups, the intraocular pressure (IOP) reduction was 2.34+/-0.19 mmHg more than those in a GI group one level lower while holding everything else constant. Those who had undergone trabectome combined with phacoemulsification had an IOP reduction that was 1.29+/-0.39 mmHg less compared to those with trabectome alone. No statistically significant difference was found between genders and age groups while holding everything else constant. Hispanics had a 3.81+/-1.08 mmHg greater IOP reduction. Pseudoexfoliation and steroid glaucoma patients had an IOP reduction that was greater by 2.91+/-0.56 and 3.86+/-0.81 mmHg, respectively, than those with primary open angle glaucoma. These results suggest a role for trabectome-mediated ab interno trabeculectomy beyond mild forms of glaucoma. Additionally, the multifactorial glaucoma index demonstrates a role in staging patients when comparing glaucoma surgical modalities.

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Section: Introductionmentioning

confidence: 99%

Combined analysis of trabectome and phaco-trabectome outcomes by glaucoma severity

et al. 2016

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“…With a baseline IOP of 11.64+/-1.45 mmHg [18], a minimum sample size of 7 is required to detect an 18% IOP reduction [23] with an alpha of 0.05 and a power of 0.80.…”

Section: Statisticsmentioning

confidence: 99%

Outflow Enhancement by Three Different ab Interno Trabeculectomy Procedures in a Porcine Anterior Segment Model

Dang¹,

Wang²,

Shah³

et al. 2018

Preprint

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Objective: To evaluate three different microincisional ab interno trabeculectomy procedures in a porcine eye perfusion model. Methods:In perfused porcine anterior segments, 90 degrees of trabecular meshwork (TM) were ablated using the Trabectome (T; n=8), Goniotome (G; n=8), or Kahook device (K; n=8). After 24 hours, additional 90 degrees of TM were removed. Intraocular pressure (IOP) and outflow facility were measured at 5 µl/min and 10 µl/min perfusion to simulate an elevated IOP. Structure and function were assessed with canalograms and histology.Results: At 5 µl/min infusion rate, T resulted in a greater IOP reduction than G or K from baseline (76.12% decrease versus 48.19% and 47.96%, P=0.013). IOP reduction between G and K was similar (P=0.420). Removing another 90 degrees of TM caused an additional IOP reduction only in T and G but not in K. Similarly, T resulted in the largest increase in outflow facility at 5 µl/min compared with G and K (first ablation: 3.41 times increase versus 1.95 and 1.87; second ablation: 4.60 versus 2.50 and 1.74) with similar results at 10 µl/min (first ablation: 3.28 versus 2.29 and 1.90 (P=0.001); second ablation: 4.10 versus 3.01 and 2.01 (P=0.001)). Canalograms indicated circumferential flow beyond the ablation endpoints.Conclusions: T, G and K significantly increased the outflow facility. In this model, T had a larger effect than G and K.

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“…ECP reduces the IOP by ablating the ciliary processes via an endoscopic probe to decrease aqueous humor production [47].…”

Section: Endoscopic Cyclophotocoagulation (Ecp)mentioning

confidence: 99%

Minimally Invasive Modalities for Treatment of Glaucoma: An Update

Lee¹,

Amoozgar²,

Han³

2017

J Clin Exp Ophthalmol

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Purpose of Review: In recent years, Minimally Invasive Glaucoma Surgery (MIGS) and laser-based procedures have been gaining popularity as glaucoma treatment options. As such, they represent active areas of research. This article reviews some of the notable recent and forthcoming developments in this field. Recent Findings:The MIGS devices and cyclophotocoagulation have been focused on achieving satisfactory success rate as either combined with phacoemulsification or standalone procedure. They also have superior safety profile when compared to traditional incisional glaucoma surgeries. In addition to the promising data available thus far, more comprehensive investigations on the long-term efficacy and safety of these interventions are currently underway.Summary: New minimally invasive surgical modalities have shown considerable potential in intraocular pressure (IOP) and the number of post-surgical medications with rare complications. The rising popularity of these devices and procedures may represent a shift in treatment paradigm from medical therapy towards earlier surgical intervention, especially in the treatment of mild-to-moderate glaucoma.

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Review and meta-analysis of ab-interno trabeculectomy outcomes

Cited by 178 publications

References 39 publications

Combined analysis of trabectome and phaco-trabectome outcomes by glaucoma severity

Combined analysis of trabectome and phaco-trabectome outcomes by glaucoma severity

Outflow Enhancement by Three Different ab Interno Trabeculectomy Procedures in a Porcine Anterior Segment Model

Minimally Invasive Modalities for Treatment of Glaucoma: An Update

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