The effect of additional trabecular aspiration to phacoemulsification and trabectome as a triple procedure in pseudoexfoliation glaucoma: a case-matched study

Widder, Randolf A.; Jordan, Jens; Kühnrich, Pia; Lübke, Jan; Roessler, Gernot; Anton, Alexandra

doi:10.1007/s10792-017-0732-y

Cited by 7 publications

(12 citation statements)

References 19 publications

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“…The procedure was performed on the remaining trabecular meshwork using a suction pressure set to 200 mm Hg, in accordance with Jacobi et al 15 Standardized postoperative topical therapy was administered, including steroid eye drops (Inflanefran forte AT, Allergan, Frankfurt, Germany), steroid ointment (Ultracortenol AS, Agepha, Senec, Slovakia), antibiotic eye drops (Floxal AT, Bausch & Lomb, Frankfurt, Germany), miotic eye drops (Spersacarpin 2% AT, Omnivision GmbH, Puchheim, Germany), as well as the previous topical anti‐glaucomatous medication. Further use of IOP‐lowering eye drops was based on the discretion of the patient's ophthalmologist 13,14 …”

Section: Methodsmentioning

confidence: 99%

Predictability of ab‐interno trabeculectomy success in the subsequent eye: A contralateral eye comparison study

Kiessling

Rennings

Hild

et al. 2021

Clinical Exper Ophthalmology

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Background To determine whether the outcome of the first eye may serve as a predictor for intraocular pressure (IOP)‐lowering effectiveness in the second eye following bilateral ab interno trabeculectomy. Methods This retrospective single‐centre study included 168 eyes from 84 participants, who underwent combined Trabectome surgery with phacoemulsification cataract surgery in a hospital setting. The clinical endpoint was defined as either ‘success’ or ‘failure’ based on four separate scores at the longest follow‐up time point: IOP at follow‐up <21 mm Hg (Score A) or IOP < 18 mm Hg (Score B), without re‐surgery and IOP reduction >20%; IOP ≤15 mm Hg without re‐surgery and IOP reduction ≥40% (Score C); and the sole absence of re‐surgery according to the discretion of the surgeon (Score D). Results No significant difference was observed between the outcomes of first and second eyes. The frequency of success in the second eye after effective surgery in the first eye significantly exceeded that after prior failure. Within our analysis, the probability calculations determined a 75% chance of success following prior success for Score A. If surgery in the first eye failed, the chance of success in the subsequent eye was 37%. The corresponding probabilities were 79% and 32% for Score B, 56% and 9% for Score C, and 99% and 50% for Score D. Conclusion The results of our study offer a useful tool to assess the success of subsequent eye surgeries based on the outcome in the initial eye, owing to the high predictive potential.

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Section: Methodsmentioning

confidence: 99%

Predictability of ab‐interno trabeculectomy success in the subsequent eye: A contralateral eye comparison study

Kiessling

Rennings

Hild

et al. 2021

Clinical Exper Ophthalmology

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“…We eventually retained 30 eyes of 30 patients in the trabectome group, of which 16 (53%) eyes were classified as Primary open angle glaucoma (POAG), 14 (47%) were classified as XFG. Standalone Trabectome surgery and combined surgery with phacoemulsification or phacoemulsification and trabecular aspiration surgery were performed in 11 (37%), 13 (43%), and six eyes (20%), respectively [21][22][23]. The mean latency between primary ab-interno trabeculectomy and XEN Gel stent implantation was 3.2 ± 1.9 years.…”

Section: Resultsmentioning

confidence: 99%

Impact of failed ab-interno trabeculectomy (trabectome) on subsequent XEN45 gel stent implantation in pseudophakic eyes

et al. 2021

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Purpose To determine the impact of failed ab-interno trabeculectomy on the postoperative outcome of subsequent XEN45 gel stent (Allergan, CA, USA) implantation in pseudophakic eyes. Methods In this retrospective single-center study, we included 60 pseudophakic eyes from 60 participants who underwent XEN45 gel stent implantation. Thirty eyes each underwent primary stent implantation (control group) or had previously undergone a failed ab-interno trabeculectomy (trabectome group). The groups were matched at a 1:1 ratio based on the following criteria: preoperative and maximum Intraocular pressure (IOP), preoperative medication score, cup/disk-ratio, follow-up time, best-corrected visual acuity at baseline, age, and the proportion of patients classified as primary open angle glaucoma or exfoliation glaucoma. We defined a successful surgery by the following three scores: an IOP reduction > 20% and IOP at the longest follow-up < 21 mmHg (Score A) or < 18 mmHg (Score B) or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (Score C). One open conjunctival revision was allowed in all scores, and a repeat surgery was considered a failure. Results Following an average follow-up period of 22 ± 12 months, we observed a mean IOP reduction of 38%, from 23.5 ± 5.2–14.5 ± 5.0 mmHg. Comparative analyses between the groups did not reveal a significant difference in the postoperative IOP, postoperative medication score, side effects, revision rate, repeat surgery rate, or success rate. Conclusions Trabectome is a viable first-line procedure for medically uncontrolled glaucoma before filtering ab-interno microstent surgery is considered.

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“…The efficacy of this combination has been investigated previously. 2,10 As a first step, it was reported that adding trabectome surgery to phaco/trabecular aspiration led to a 38% reduction instead of a 27% reduction in IOP. 2 However, the contribution of trabecular aspiration to the phaco/trabectome combination leading to a further lowering of IOP has been questioned.…”

Section: Discussionmentioning

confidence: 99%

“…The surgical procedure was explained in detail earlier. 2,10 The surgery began with a 1.7 to 1.8 mm corneal incision from the temporal side. Then, the head of the patient was rotated and the trabectome was inserted into the anterior chamber under a stabilising infusion.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…[6][7][8][9] It was also shown that the triple procedure, comprising phacoemulsification, trabectome surgery and trabecular aspiration, had a better pressure-lowering effect than phacoemulsification combined with only one of these techniques. 2,10 However, the duration of the effect has been questioned; a long-lasting effect on intraocular pressure in patients with exfoliation glaucoma is required. This was investigated in this study for over 7 years.…”

Section: Introductionmentioning

confidence: 99%

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Trabectome, trabecular aspiration and phacoemulsification in a triple procedure for treating exfoliation glaucoma: A long-term follow-up

Widder

Hild

Dietlein

et al. 2020

European Journal of Ophthalmology

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Purpose: This study investigates the long-term intraocular pressure (IOP) lowering potential, risk profile and success rate of a triple procedure comprising phacoemulsification, trabecular aspiration and trabectome (Microsurgical Technology, Redmond, WA, USA) for treating exfoliation glaucoma. Methods: A total of 117 eyes of 117 patients with exfoliation glaucoma underwent a combination of phacoemulsification, trabectome and trabecular aspiration. They were followed up for up to 7 years. The success rates were designated according to criteria based on the Tube versus Trabeculectomy Study and the World Glaucoma Association guidelines: A (no resurgery); B/C (IOP < 21/18 mmHg, no resurgery, IOP reduction > 20%); D (IOP ⩽ 15 mmHg, no resurgery, IOP reduction ⩾ 40%). Results: The mean follow-up period was 46 months. IOP showed a 38% reduction from 24.5 ± 6.1 to 15.2 ± 3.6 mmHg ( p < 0.0001). The Medication Score decreased by 23% from 2.2 ± 0.9 to 1.7 ±1.0 ( p < 0.0001). The success rates were 87, 76, 74 and 38% according to criteria A, B, C and D. In eyes with an initial IOP of >30 mmHg, a 57% reduction from 34.2 ± 4.4 to 14.8 ± 3.2 mmHg ( p < 0.0001) was observed, and the success rates were 91, 91, 82 and 59% for criteria A, B, C and D, respectively. Discussion: We conclude that the triple procedure may effectively lower IOP in patients with exfoliation glaucoma over a mean follow-up period of 46 months without significant side effects. Therefore, the triple procedure may serve as first-line surgery for patients with exfoliation and cataract, even with a high initial IOP.

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The effect of additional trabecular aspiration to phacoemulsification and trabectome as a triple procedure in pseudoexfoliation glaucoma: a case-matched study

Cited by 7 publications

References 19 publications

Predictability of ab‐interno trabeculectomy success in the subsequent eye: A contralateral eye comparison study

Predictability of ab‐interno trabeculectomy success in the subsequent eye: A contralateral eye comparison study

Impact of failed ab-interno trabeculectomy (trabectome) on subsequent XEN45 gel stent implantation in pseudophakic eyes

Trabectome, trabecular aspiration and phacoemulsification in a triple procedure for treating exfoliation glaucoma: A long-term follow-up

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