Trabeculotomy Ab Externo: An Alternative Treatment in Adult Patients With Primary Open-Angle Glaucoma

Chihara, Etsuo; Nishida, Akihiro; Kodo, Midori; Yoshimura, Nagahisa; Matsumura, Miyo; Yamamoto, Miho; Tsukada, Takako

doi:10.3928/1542-8877-19931101-06

Cited by 30 publications

(16 citation statements)

References 20 publications

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“…Trabeculotomy is effective for the reduction in intraocular pressure (IOP) in patients with glaucoma [ 1 , 2 , 3 , 4 ]. The trabecular meshwork and inner walls of Schlemm’s canal are the main sites of resistance to aqueous outflow [ 1 , 5 , 6 ].…”

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confidence: 99%

Long-Term Outcomes of a Kahook Dual Blade Procedure Combined with Phacoemulsification in Japanese Patients with Open-Angle Glaucoma

Iwasaki

Kakimoto

Orii

et al. 2022

JCM

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We retrospectively evaluated the long-term surgical outcomes of phacoemulsification combined with a Kahook dual blade (KDB) procedure in Japanese patients with open-angle glaucoma. The primary outcome was surgical success or failure. Surgical failure was indicated by a <20% reduction in preoperative intraocular pressure (IOP) or IOP > 18 mmHg (criterion A), IOP > 14 mmHg (criterion B), or requirement for reoperation. Glaucoma medications after surgery and postoperative complications were recorded. Surgical outcomes were compared between primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) groups. The probability of success at 36 months postoperation was 52.5% using criterion A and 36.9% using criterion B. Mean IOP decreased significantly from 19.5 ± 6.9 mmHg preoperatively to 11.9 ± 2.7 mmHg at 36 months, and the mean number of glaucoma medications from 2.4 ± 1.4 to 1.6 ± 1.4 (both p < 0.01). IOP spikes were significantly more common in the ExG group (23.7% vs. 9.1%; p = 0.045), as was the need for additional glaucoma surgery (10.5% vs. 1.8%; p = 0.038). A KDB procedure combined with cataract surgery resulted in significant long-term decreases in IOP and the number of glaucoma medications. The complication rate was higher in eyes with ExG. Therefore, these eyes require more careful management after a KDB procedure.

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Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of a Kahook Dual Blade Procedure Combined with Phacoemulsification in Japanese Patients with Open-Angle Glaucoma

Iwasaki

Kakimoto

Orii

et al. 2022

JCM

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“…Trabeculotomy (LOT) lowers intraocular pressure (IOP) by reducing aqueous flow resistance by cleaving the trabecular meshwork (TM) and inner walls of Schlemm's canal [1]. The blebless mechanism of IOP reducing action in LOT is associated with less chance of devastating visual complications including shallow anterior chamber (AC), bleb leakage, blebitis, choroidal detachment, and hypotony maculopathy than those in mitomycin Cadjuvanted trabeculectomy [2,3]. In recent years, ab interno approaches have been adopted for performing LOT procedures [4,5].…”

Section: Introductionmentioning

confidence: 99%

Effects of Preoperative Intraocular Pressure Level on Surgical Results of Microhook Ab Interno Trabeculotomy

Tanito

Sugihara

Tsutsui

et al. 2021

JCM

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To assess the roles of preoperative intraocular pressure (IOP) level on the IOP reducing efficacy of microhook ab interno trabeculotomy (µLOT), 126 consecutive open-angle glaucomatous eyes (90 primary open angle glaucoma, 36 exfoliation glaucoma) of 126 Japanese subjects (60 men, 66 women; mean age ± standard deviation, 70.5 ± 11.4 years) who underwent µLOT alone (25 eyes, 20%) or combined µLOT and cataract surgery (101 eyes, 80%) were retrospectively included, and subdivided into four groups based on the quartile of preoperative IOP: Q1, ≤15 mmHg; Q2, 15–18 mmHg, Q3, 18–21 mmHg, and Q4, >21 mmHg. Preoperative and 12 months postoperative IOPs and numbers of antiglaucoma medications were compared among IOP groups. Factors associated with postoperative IOP were assessed using multivariate analysis, and the success of IOP control was assessed with various definitions. Postoperatively, IOP was significantly higher in Q3 (p < 0.0146) and Q4 (p = 0.0320) groups than Q1 group, while the number of medications was not significantly different among four IOP groups (p = 0.1966). Older age was associated with lower postoperative IOP, and higher preoperative IOP was associated with higher postoperative IOP, while sex, glaucoma type, surgical procedure, lens status, extent of trabeculotomy incision, and preoperative number of medications were not associated with postoperative IOP. The success rates for IOP ≤ 18 and ≤15 mmHg were higher in lower preoperative IOP groups (i.e., Q1 and Q2) than higher preoperative IOP groups (Q3 and Q4), while the success rate for ≥20% IOP reduction was higher in higher preoperative IOP groups than in lower preoperative IOP groups; the success rate for ≥0% IOP reduction was equivalent among groups. By reviewing the previous studies in ab interno trabeculotomy/goniotomy procedures, positive correlation between preoperative and postoperative IOPs was preserved throughout the studies and surgical procedures. After the µLOT, larger %IOP reduction was achieved in higher preoperative IOP groups than in lower preoperative IOP groups, while postoperative IOP was still lower than in lower preoperative IOP groups.

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“…The idea that the mechanical cleavage of the trabecular meshwork can relieve the resistance to aqueous flow—thus reducing IOP—is not new. Ab externo trabeculotomy has been indicated as an alternative among the surgical approaches to open-angle glaucoma (OAG) for decades 3,4. However, only recently have ab interno trabeculotomy techniques emerged as less invasive options, since they spare conjunctival and scleral tissue from manipulation.…”

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confidence: 99%

Gonioscopy-Assisted Transluminal Trabeculotomy for Glaucoma: 1-Year Outcomes and Success Predictors

Faria

Costa

Melillo

et al. 2022

Journal of Glaucoma

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Précis: Our results suggest gonioscopy-assisted transluminal trabeculotomy (GATT) as an effective and safe option for the surgical management of open-angle glaucoma (OAG). Older age was the only risk factor for failure in our analysis. Purpose: To report 12-month clinical outcomes, safety profile and success predictors of GATT in patients with OAG. Patients and Methods: A retrospective study of patients (18 y old and above) with medically uncontrolled OAG who underwent GATT as a solo procedure or combined with phacoemulsification (PHACO-GATT) between January 2018 and January 2020. Success at 12 months (primary outcome) was defined as intraocular pressure (IOP) <15 mm Hg, with an IOP reduction of at least 20%, OR a reduction of at least 2 glaucoma medications, compared with baseline. Secondary outcomes were success predictors and safety parameters. Results: A total of 73 eyes (GATT=38; PHACO-GATT=35) from 58 patients with a mean age of 54.8±11.6 years were included. Overall, after 12 months of follow-up, the mean IOP was reduced from 24.9±8.5 to 12.1±2.1 mm Hg (P<0.001). The mean number of glaucoma medications was reduced from 3.5±0.7 to 1.2±1.2 (P<0.001). The success rate was 87% at 12 months, with no significant differences between GATT (85%) and PHACO-GATT (91%) eyes (P=0.330). Age was the only factor significantly associated with surgical success (hazard ratio=1.35; P=0.012; after adjusting for preoperative IOP and number of glaucoma medications). Patients older than 60 years had a significant greater chance of failure (hazard ratio=10.96; P=0.026) compared with those younger than 60 years. The most common postoperative complication was transient hyphema (39%; median duration, 5 d). No sight-threatening adverse event was documented. Conclusions: GATT was effective and safe at lowering IOP with or without cataract extraction in OAG. Patients 60 years or older had a higher risk of failure compared with those younger in age.

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Trabeculotomy Ab Externo: An Alternative Treatment in Adult Patients With Primary Open-Angle Glaucoma

Cited by 30 publications

References 20 publications

Long-Term Outcomes of a Kahook Dual Blade Procedure Combined with Phacoemulsification in Japanese Patients with Open-Angle Glaucoma

Long-Term Outcomes of a Kahook Dual Blade Procedure Combined with Phacoemulsification in Japanese Patients with Open-Angle Glaucoma

Effects of Preoperative Intraocular Pressure Level on Surgical Results of Microhook Ab Interno Trabeculotomy

Gonioscopy-Assisted Transluminal Trabeculotomy for Glaucoma: 1-Year Outcomes and Success Predictors

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