A new surgical triple procedure in pseudoexfoliation glaucoma using cataract surgery, Trabectome, and trabecular aspiration

Widder, Randolf A.; Dinslage, Sven; Rosentreter, André; Jordan, Jens; Kühnrich, Pia; Cursiefen, Claus; Lemmen, Klaus Dieter; Dietlein, Thomas S.

doi:10.1007/s00417-014-2795-z

Cited by 28 publications

(26 citation statements)

References 18 publications

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“…Two compared phaco-AIT with trabecular aspiration and found lower IOPs with phaco-AIT 21 45. An abstract compared 52 phaco-AITs with 49 phacoemulsification procedures where 2 iStents were inserted.…”

Section: Resultsmentioning

confidence: 99%

“…AIT can be expected to lower the IOP by approximately 36% to a final average IOP around 16 mm Hg. To try to give some type of comparison from the available data, a single iStent has been shown to reduce the IOP by 8%43–27%47 with an overall mean final IOP near 17 mm Hg with significantly greater reductions reported when inserting more than one stent 46. Endoscopic cyclophotocoagulation used for POAG (as opposed to neovascular glaucoma) decreases the IOP by 8%48–47%,49 to a final average near 15 mm Hg.…”

Section: Resultsmentioning

confidence: 99%

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Review and meta-analysis of ab-interno trabeculectomy outcomes

et al. 2016

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We analysed all of the PubMed publications on ab-interno trabeculectomy (AIT) with the Trabectome (Neomedix, Irvine, California, USA) to determine the reduction in intraocular pressure (IOP) and medications following the procedure. For IOP outcomes, PubMed was searched for 'trabectome', 'ab interno trabeculotomy' and 'ab interno trabeculectomy' and all available papers retrieved. The meta-analysis used a random-effects model to achieve conservative estimates and assess statistical heterogeneity. To investigate complications, we included all abstracts from the American Glaucoma Society, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery and the Association for Research in Vision and Ophthalmology. The overall arithmetic mean baseline IOP for standalone Trabectome was 26.71±1.34 mm Hg and decreased by 10.5±1.9 mm Hg (39% decrease) on 0.99±0.54 fewer medications. Defining success as IOP ≤21 with a 20% decrease while avoiding reoperation, the overall average success rate after 2 years was 46±34%. For combined phacoemulsification-Trabectome, the baseline IOP of 21±1.31 mm Hg decreased by 6.24±1.98 mm Hg (27% decrease) on 0.76±0.35 fewer medications. The success rate using the same definition at 2 years was 85±7%. The weighted mean IOP difference from baseline to study endpoint was 9.77 mm Hg (95% CI 8.90 to 10.64) standalone and 6.04 mm Hg (95% CI 4.95 to 7.13) for combined cases. Despite heterogeneity, meta-analysis showed significant and consistent decrease in IOP and medications from baseline to end point in AIT and phaco-AIT. The rate of visually threatening complications was <1%. On average, trabectome lowers the IOP by approximately 31% to a final IOP near 15 mm Hg while decreasing the number of medications by less than one, with a low rate of serious complications. After 2 years, the overall average success rate is 66%.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Review and meta-analysis of ab-interno trabeculectomy outcomes

et al. 2016

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“…Steroid glaucoma and pseudoexfoliation often produce very high IOPs and the primary pathology is located in the trabecular meshwork. As a result, ablating the meshwork reduces intraocular pressure very effectively 17 .…”

Section: Discussionmentioning

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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“…Literature investigating TA in XFG remains limited; however, more recent studies have been conducted in which TA is used in conjunction with or compared with ab interno trabeculectomy with Trabectome. In one retrospective study of 30 patients, a triple surgical procedure of cataract extraction, Trabectome and TA was compared with cataract extraction and TA alone 107. The study found that the triple procedure group had a significantly greater reduction in IOP compared with the control group (38.4% vs 26.8%).…”

Section: Exfoliative Glaucomamentioning

confidence: 99%

What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago?

Nazarali

Damji

2018

Br J Ophthalmol

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Exfoliation syndrome (XFS) is a systemic disease with significant ocular manifestations, including glaucoma and cataract. The disease impacts close to 70 million people globally and is now recognised as the most common identifiable cause of open-angle glaucoma. Since the discovery of XFS 100 years ago by Dr John G. Lindberg, there has been considerable advancement in understanding its pathogenesis and resulting clinical implications. The purpose of this paper is to summarise information regarding the epidemiology, pathophysiology, ocular manifestations and systemic associations of XFS with the objective of sharing clinical pearls to assist in early detection and enhanced management of patients.

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A new surgical triple procedure in pseudoexfoliation glaucoma using cataract surgery, Trabectome, and trabecular aspiration

Abstract: The triple procedure is more effective in lowering intraocular pressure compared to phacoemulsification and trabecular aspiration alone in pseudoexfoliation glaucoma.

Cited by 28 publications

References 18 publications

Review and meta-analysis of ab-interno trabeculectomy outcomes

Review and meta-analysis of ab-interno trabeculectomy outcomes

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

What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago?

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