Efficacy of Modified 360-degree Suture Trabeculotomy for Pseudoexfoliation Glaucoma

Abstract

Purpose: In this prospective study, we aimed to investigate the success and safety of a modified 360-degree suture trabeculotomy (ST) technique in patients with pseudoexfoliation glaucoma (XFG).Patients and Methods: The modified 360-degree ST was performed on 15 eyes of 15 patients with XFG resistant to maximal topical treatment. In 6 patients, ST was combined with phacoemulsification. Main outcome measures were the surgical success rate, mean postoperative intraocular pressure (IOP), the number of antiglaucoma medications, and the operative complications.Results: The mean follow-up period was 8 months (range 6 to 12 mo). Baseline IOP decreased from 27.53 ± 9.38 mm Hg on 3.26 ± 0.70 medications to 12.86 ± 2.72 mm Hg (P = 0.01) on 0.20 ± 0.56 medications (P = 0.01) at 6 months postoperatively accounting for a 52.82% reduction. The complete and qualified success rates were 77% and 100%, respectively, at the sixth month. The entire circumference of the Schlemm canal was successfully opened in all cases. Hyphema (in all cases), intraoperative iris prolapse (in 3 cases), transient elevation of the IOP (in 1 case), posterior synechia (in 2 phakic cases), and peripheral anterior synechia (in 1 case) were noted. There was not a trend for lower IOP after combined phacomodified 360-degree ST in this small group.Conclusions: The modified 360-degree ST appears to be a valuable option for the surgical treatment of XFG. Future studies are needed to explore the remote side effects and the long-term effects of this procedure on IOP.A s a filtering surgery, trabeculectomy with adjunctive mitomycin C is associated with a high incidence of postoperative complications such as bleb leaks, blebitis, shallow anterior chambers, choroidal detachments, hypotensive maculopathy, cataract progression, and unpredictable postoperative intraocular pressure (IOP) levels. 1 Schlemm canal (SC) surgeries (eg, trabeculotomy, viscocanalostomy, and canaloplasty) are a valuable alternative to glaucoma filtration surgery. 2,3 They target the abnormally high resistance to outflow in the trabecular meshwork (TM) and enhance outflow through the patient's own natural drainage system. 4 It is common knowledge that trabeculotomy ab externo is effective for management of congenital glaucoma, but its efficacy for adult glaucoma is less known. A 360-degree trabeculotomy technique using a 6-0 polypropylene suture was reported by Beck and Lynch 5 in 1995 for congenital glaucoma, with high surgical success rates compared with conventional trabeculotomy with metal trabeculotomes. The only study evaluating the 360-degree suture trabeculotomy (ST) in adult patients with open-angle glaucoma was reported by Chin et al. 6 They found that 360-degree ST ab externo was significantly more effective than metal trabeculotomy in lowering IOP in adult primary and secondary open-angle glaucomas. They also modified the 360-degree ST by making a deep scleral flap that allowed clearly identifying SC, and showed a success rate of 84% for adult open-angle glaucoma. However, the study ...

Modified 360-degree suture trabeculotomy combined with phacoemulsification and intraocular lens implantation for glaucoma and coexisting cataract

“…12 Recently, Hepşen et al reported that the modified 360-degree suture trabeculotomy was also effective for XG eyes, and the mean postoperative IOP value was 12.9±2.7 mmHg at 6 months after surgery. 18 They performed the ST-CS technique in 6 patients with XG, achieving favorable outcomes similar or equivalent to the ST surgery alone in 15 patients with exfoliation glaucoma, in accordance with our present data. In this study, there were no serious complications such as shallow anterior chamber, choroidal detachment, aqueous misdirection, infection, or wound leaks, as seen after trabeculectomy with mitomycin C. There was no case of local descemetolysis in our present study or in our previous study with the ST technique alone.…”

Are the outcomes of circumferential trabeculotomy for adult open angle glaucoma comparable to those of trabeculectomy?

“…In Group 2, standard nonpenetrating incision technique described for viscocanalostomy and canaloplasty was performed. Schlemm canal was cannulated circumferentially using a 6‐0 polypropylene suture with a blunted tip as defined by Hepsen et al . The 360° trabeculotomy was modified as described by Chin et al …”

Evaluation of peripheral anterior synechia formation following gonioscopy-assisted transluminal trabeculotomy surgery

“…Development of peripheral anterior synechia (PAS) formation has been reported following both ab-interno and abexterno trabeculotomy procedures [12][13][14]. Presence of PAS may have a chance to occlude the cleavage plane in these eyes leading to decreased aqueous out ow, thereby reducing the effect of the surgery.…”