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

Abstract

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.

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

“…In eyes with exfoliation glaucoma, additional trabecular aspiration was performed as previously described 12‐14 . Briefly, trabecular aspiration was completed with the pre‐existing paracenteses via a specially designed bent cannula with an outer diameter of 400 μm, linked to an irrigation and aspiration device.…”

“…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 …”

“…In eyes with exfoliation glaucoma, additional trabecular aspiration was performed as previously described. [12][13][14] Briefly, trabecular aspiration was completed with the preexisting paracenteses via a specially designed bent cannula with an outer diameter of 400 μm, linked to an irrigation and aspiration device. 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…”

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

“…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.…”