Long-Term Clinical Results of Ab-Interno Trabeculotomy in Glaucoma Management
Glaucoma is one of the leading causes of irreversible vision loss worldwide. Elevated intraocular pressure (IOP) is the most important risk factor for the development and progression of the disease.
Ab-interno trabeculotomy (AIT) using the Trabectome system is a minimally invasive glaucoma surgery (MIGS) that reduces aqueous humor outflow resistance by ablating the trabecular meshwork and the inner wall of Schlemm's canal, thereby lowering intraocular pressure.
Previous studies have demonstrated good short-term efficacy of this procedure. However, robust long-term data spanning several years remain scarce.
The aim of this study is to evaluate the long-term outcomes of AIT in glaucoma patients who underwent surgery between 2019 and 2021 at the Department of Ophthalmology, University Hospital Würzburg. Patients are invited for a single study visit at which intraocular pressure, visual acuity, anterior chamber angle by gonioscopy, and optic nerve structure by optical coherence tomography (OCT) are assessed. The collected data are compared with pre-operative baseline values obtained from medical records.
The results are intended to improve the assessment of long-term surgical success and to optimize patient selection for this procedure in the future.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Glaucoma is a progressive optic neuropathy in which elevated intraocular pressure (IOP) represents the primary modifiable risk factor. Ab-interno trabeculotomy (AIT) with the Trabectome is a minimally invasive glaucoma surgery (MIGS) that reduces IOP by ablating the trabecular meshwork and inner wall of Schlemm's canal, thereby improving aqueous humor outflow.
Previous studies have demonstrated favorable short-term IOP reduction and a good safety profile. However, robust long-term data evaluating sustained surgical success, disease progression, and the need for additional interventions over multiple years are currently lacking.
This single-center, observational study with a retrospective pre-operative baseline and a prospective cross-sectional follow-up visit addresses this knowledge gap. Patients who underwent AIT at the Department of Ophthalmology, University Hospital Würzburg, are contacted and invited for a single study visit of approximately 30 minutes.
At this visit, the following assessments are performed:
- Medical history review since the time of surgery
- Visual acuity assessment
- Goldmann applanation tonometry (IOP measurement)
- Slit-lamp biomicroscopy including gonioscopy for the anterior chamber angle
- Optical coherence tomography (OCT) of the optic nerve head and retinal nerve fiber layer (RNFL)
All examinations are non-invasive, painless, and consistent with routine ophthalmic care. No additional follow-up visits are required beyond this single study contact.
Pre-operative data, including baseline IOP, glaucoma diagnosis, medication use, and surgical details are obtained from existing medical records. These are compared with findings at the study visit to evaluate long-term treatment success.
The study is initiated and funded by the Department of Ophthalmology, University Hospital Würzburg. No external funding or industry sponsorship is involved. The study has been approved by the responsible Ethics Committee with no objections raised.
Approximately 180 participants are planned for enrollment. Data are pseudonymized and stored on password-protected servers. No data transfer to third parties or outside the European Union is performed. Data will be deleted no later than 10 years after study completion.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Raoul Verma-Führing, Dr.
- Phone Number: +49 931 20120458
- Email: augenklinik@ukw.de
Study Contact Backup
- Name: Eric Schreiner
- Email: ericschreiner03studium@gmail.com
Study Locations
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Bavaria
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Würzburg, Bavaria, Germany, 97080
- Recruiting
- University Hospital Würzburg
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Contact:
- Raoul Verma-Führing
- Phone Number: +49 931 20120351
- Email: augenklinik@ukw.de
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Diagnosis of glaucoma
- Previous ab-interno trabeculotomy (AIT) using the Trabectome device performed at the Department of Ophthalmology, University Hospital Würzburg
- Surgery performed between 2019 and 2021
- Ability to provide written informed consent
- Age ≥ 18 years at time of surgery
Exclusion Criteria:
- Inability to attend the study visit
- Withdrawal of informed consent
- Insufficient medical records for pre-operative baseline data retrieval
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
|---|---|
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AIT Cohort
Tha AIT cohort consists of glaucoma patients who previously underwent ab-interno trabeculotomy (AIT) using the Trabectome device at the Department of Ophthalmology, University Hospital Würzburg.
Participants are invited for a single follow-up visit to assess long-term intraocular pressure control, visual acuity, optic nerve status (OCT), and visual field outcomes compared to pre-operative baseline data obtained from medical records.
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Ab-interno trabeculotomy (AIT) is a minimally invasive glaucoma surgery (MIGS) performed using the Trabectome device.
The procedure ablates the trabecular meshwork and the inner wall of Schlemm's canal via an ab-interno approach, thereby reducing resistance to aqueous humor outflow and lowering intraocular pressure.
The surgery is performed under local or general anesthesia and can be combined with cataract surgery.
In this observational study, the intervention was performed prior to study enrollment; no surgical intervention is performed as part of the study itself.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change in Intraocular Pressure (IOP) from Pre-operative Baseline to Follow-up
Time Frame: From pre-operative baseline to single follow-up visit (minimum 4 years, up to 10 years post-surgery)
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Mean intraocular pressure (mmHg) measured by Goldmann applanation tonometry at the study visit, compared to pre-operative baseline IOP obtained from medical records.
Surgical success is defined as IOP reduction of ≥20% from baseline and/or IOP ≤18 mmHg, with or without anti-glaucomatous medication.
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From pre-operative baseline to single follow-up visit (minimum 4 years, up to 10 years post-surgery)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change in Number of Intraocular Pressure-Lowering Medications from Pre-operative Baseline to Follow-up
Time Frame: From pre-operative baseline to single follow-up visit (minimum 4 years, up to 10 years post-surgery)
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Total number of topical and systemic anti-glaucomatous medications used by the patient at the time of the study visit, compared to the number documented in medical records prior to surgery.
Reduction in medication burden is considered an additional indicator of surgical success.
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From pre-operative baseline to single follow-up visit (minimum 4 years, up to 10 years post-surgery)
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Visual Acuity at Follow-up
Time Frame: At single follow-up visit (minimum 4 years, up to 10 years post-surgery)
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Visual acuity assessed using standardized visual acuity charts at the study visit.
Results are recorded in decimal notation and converted to logMAR for analysis.
Pre-operative VA is obtained from medical records for comparison.
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At single follow-up visit (minimum 4 years, up to 10 years post-surgery)
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Peripapillary Retinal Nerve Fiber Layer (RNFL) Thickness as Measured by Optical Coherence Tomography (OCT)
Time Frame: At single follow-up visit (minimum 4 years, up to 10 years post-surgery)
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Peripapillary RNFL thickness (µm) assessed by spectral- domain optical coherence tomography (SD-OCT) at the study visit.
Global and sectoral RNFL values are recorded.
Results are compared to pre-operative OCT data from medical records where available, to evaluate structural progression of glaucomatous optic neuropathy.
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At single follow-up visit (minimum 4 years, up to 10 years post-surgery)
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Rate of Surgical Failure Requiring Additional IOP-Lowering Intervention After Ab-Interno Trabeculotomy
Time Frame: From date of surgery to single follow-up visit (minimum 4 years, up to 10 years post-surgery)
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Proportion of patients who required additional surgical or laser intervention (e.g., trabeculectomy, tube shunt implantation, selective laser trabeculoplasty) due to insufficient IOP control following AIT.
Data obtained retrospectively from medical records.
Surgical failure is defined as the need for re-intervention at any time point after the primary procedure.
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From date of surgery to single follow-up visit (minimum 4 years, up to 10 years post-surgery)
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Raoul Verma-Führing, Dr., Wuerzburg University Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2025-330-dvha
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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