Ab interno trabecular bypass surgery with Trabectome for open angle glaucoma

Hu, Kuang; Gazzard, Gus; Bunce, Catey; Wormald, Richard

doi:10.1002/14651858.cd011693.pub2

Cited by 23 publications

(5 citation statements)

References 45 publications

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“…In the current study, the survival, IOP reduction, and duration of postoperative hyphema were comparable regardless of pilocarpine use. Both groups experienced an IOP reduction like that observed in previous studies 5 , 6 , 30 .…”

Section: Discussionsupporting

confidence: 83%

Extended pharmacological miosis is superfluous after glaucoma angle surgery: A retrospective study

et al. 2018

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Background: Pilocarpine is commonly used after angle surgery for glaucoma despite a host of side effects and risks. We hypothesized that a pharmacological miosis during the first two months does not improve short- and long-term results of trabectome-mediated ab interno trabeculectomy. Methods: In this retrospective comparative 1-year case series, we compared 187 trabectome surgery eyes with (P+) or without (P-) 1% pilocarpine for two months. Primary outcome measures were the surgical success defined as intraocular pressure (IOP) ≤ 21 mmHg and decreased ≥ 20%, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, and IOP. Results: We categorized 86 (46%) eyes as P- and 101 (54%) eyes as P+. The mean age was 69.8±10.1 in P- and 70.5±9.4 in P+ (P=0.617) with equal gender distribution (P=0.38). The cumulative probability of qualified success at 12 months was 78.1% in the P- and 81% in the P+ (P=0.35). The IOP was decreased significantly from 20.2±6.8 mmHg at baseline to 15.0±4.8 mmHg at 12 months follow-up in P- (P=0.001) and 18.8±5.3 and 14.7±4.0, respectively (P=0.001). The medications decreased significantly from 1.4±1.2 in P- and 1.4±1.2 in P+ at baseline to 1.0±1.2 and 0.7±1.0, respectively (P=0.183). P- and P+ did not differ in IOP or medications (all P>0.05). In Multivariate Cox Regression models, the baseline IOP and central corneal thickness were associated with failure. Conclusions: Use of postoperative pilocarpine does not improve the efficacy of trabectome surgery.

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Section: Discussionsupporting

confidence: 83%

Extended pharmacological miosis is superfluous after glaucoma angle surgery: A retrospective study

et al. 2018

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“…No randomized controlled trials for Trabectome have been completed. 9,10 Our results achieved similar IOP lowering and success rates as these studies. In the meta-analysis by Kaplowitz et al, 4 the preoperative IOP was considerably different between cases undergoing standalone and combined surgery (26.7 vs. 21.0 mm Hg), but still lower than our cohort (32.9 vs. 30.4 mm Hg).…”

Section: Discussionsupporting

confidence: 80%

“…Bendel and Patterson8 report outcomes through to 8 years with maintenance of IOP lowering in 80% by Kaplan-Meier analysis. No randomized controlled trials for Trabectome have been completed 9,10…”

Section: Discussionmentioning

confidence: 99%

Early Results of Irrigating Goniectomy With TrabEx+: A Novel Device for the Treatment of Open-angle Glaucoma

Gosling

Wang

Auger

2022

Journal of Glaucoma

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Précis: Irrigating goniectomy with the TrabEx+ device can lower intraocular pressure (IOP) in patients with glaucoma, as a standalone procedure or combined with cataract surgery. Purpose: The aim was to describe the efficacy and safety of irrigating goniectomy performed using the TrabEx+ device, either as a standalone procedure or combined with cataract surgery, in eyes with medically treated open-angle glaucoma. Methods: A retrospective case series of eyes treated by a single surgeon at a single UK teaching hospital. Data was collected at follow-up visits at 1 week, 3, 6, 12, 18, and 24 months postoperatively. Primary outcomes included IOP and glaucoma medication reduction after surgery. Proportion of eyes achieving >20% IOP reduction, IOP <21 mm Hg, and no reoperation were classified as surgical success. Results: Seventy-three consecutive eyes of 64 patients (mean age 68.4±13.7 y) were enrolled. 62% were treated as combined procedures with cataract surgery. Overall, mean IOP decreased from 31.3±7.3 to 20.9±10.4 mm Hg at the latest follow-up (34% reduction) (P<0.001) at the latest follow-up (16.1±10.3 mo) with mean preoperative medications decreased from 2.9±1.2 to 1.9±1.3 (P<0.001). 73% met the definition of success at latest follow-up. Postoperative complications were recorded including hyphaema (17%), uveitis (3%), hypotony (1%), and persistent vitreous hemorrhage (1%). Eighteen percent required reoperation because of treatment failure. Conclusion: TrabEx+ appears to be effective in lowering IOP and medication with or without cataract surgery. However, long-term safety and efficacy will be better understood in a prospective study with longer follow-up.

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“…However, the current literature suggests that additional research is warranted to best understand how to maximize the utility of Trabectome in the management of glaucoma patients. Even though the Trabectome has been available for over ten years, no randomized controlled trials have been published comparing the Trabectome with other potential glaucoma treatments [ 24 ]. As a result, it is challenging for hospitals, physicians, and other decision-makers to determine if the available evidence is sufficient to warrant publicly funded access to innovations in technology such as the Trabectome.…”

Section: Discussionmentioning

confidence: 99%

When Is Evidence Enough Evidence? A Systematic Review and Meta-Analysis of the Trabectome as a Solo Procedure in Patients with Primary Open-Angle Glaucoma

Chow

Hutnik

Solo

et al. 2017

Journal of Ophthalmology

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The purpose of this systematic review and meta-analysis was to examine the availability of evidence for one of the earliest available minimally invasive glaucoma surgery (MIGS) procedures, the Trabectome. Various databases were searched up to December 20, 2016, for any published studies assessing the use of the Trabectome as a solo procedure in patients with primary open-angle glaucoma (POAG). The standardized mean differences (SMD) were calculated for the change in intraocular pressure (IOP) and number of glaucoma mediations used at 1-month, 6-month, and 12-month follow-up. After screening, three studies and one abstract with analyzable data were included. The meta-analysis showed statistically significant reductions in IOP and number of glaucoma medications used at all time points. Though the Trabectome as a solo procedure appears to lower IOP and reduces the number of glaucoma medications, more high-quality studies are required to make definitive conclusions. The difficulty of obtaining evidence may be one of the many obstacles that limit a full understanding of the potential safety and/or efficacy benefits compared to standard treatments. The time has come for a thoughtful and integrated approach with stakeholders to determine optimal access to care strategies for our patients.

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Ab interno trabecular bypass surgery with Trabectome for open angle glaucoma

Cited by 23 publications

References 45 publications

Extended pharmacological miosis is superfluous after glaucoma angle surgery: A retrospective study

Extended pharmacological miosis is superfluous after glaucoma angle surgery: A retrospective study

Early Results of Irrigating Goniectomy With TrabEx+: A Novel Device for the Treatment of Open-angle Glaucoma

When Is Evidence Enough Evidence? A Systematic Review and Meta-Analysis of the Trabectome as a Solo Procedure in Patients with Primary Open-Angle Glaucoma

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