Outcomes of ab interno trabeculectomy with the trabectome by degree of angle opening

I I Bussel, K Kaplowitz, J S Schuman, N A Loewen, Trabectome Study Group, I I Bussel, K Kaplowitz, J S Schuman, N A Loewen, Trabectome Study Group

Abstract

Aim: To analyse ab interno trabeculectomy (AIT) with the trabectome and combined phacoemulsification with AIT (phaco-AIT) by Shaffer angle grade (SG).

Methods: Prospective study of AIT and phaco-AIT with narrow angles of SG≤2 versus open angles ≥3. Outcomes included intraocular pressure (IOP), medications, complications, secondary surgery and success (IOP <21 mm Hg and >20% reduction without further surgery). Exclusion criteria were missing preoperative data and <1 year follow-up.

Results: Of 671 included cases, at 1 year AIT SG≤2 (n=43) had an IOP reduction of 42% from 27.3±7.4 to 15.7±3.0 mm Hg (p<0.01) versus AIT SG≥3 (n=271) with an IOP reduction of 37% from 26.1±7.8 to 16.4±3.9 mm Hg (p<0.01). In phaco-AIT with SG≤2 (n=48), IOP was reduced 24% from 20.7±7.0 to 15.7±3.6 mm Hg (p<0.01) versus phaco-AIT with SG≥3 (n=309) with an IOP reduction of 25% from 22.6±6.4 to 17.0±3.4 mm Hg (p<0.01). There was no difference between SG≤2 and SG≥3 in reduction of IOP or medications, complications, secondary surgery and success rates (p>0.05).

Conclusions: SG≤2 is not associated with worse outcomes in AIT or phaco-AIT.

Keywords: Angle; Anterior chamber; Glaucoma; Treatment Surgery.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Trabectome Study Group Database. Cases analysed after accounting for exclusion criteria. AIT, ab interno trabeculectomy; phaco-AIT, phacoemulsification cataract surgery combined with ab interno trabeculectomy; SG, Shaffer grade.
Figure 2
Figure 2
In AIT, no significant differences were found in IOP and glaucoma medications use between in patients with a narrow (SG≤2, n=43) and a deep anterior chamber angle (SG≥3, n=271) over a 1 year period. AIT, ab interno trabeculectomy; IOP, intraocular pressure; SG, Shaffer grade.
Figure 3
Figure 3
In phaco-AIT, no significant differences were found in IOP and glaucoma medications use between in patients with a narrow (SG≤2, n=48) and a deep anterior chamber angle (SG≥3, n=309) over a 1 year period. AIT, ab interno trabeculectomy; IOP, intraocular pressure; SG, Shaffer grade.
Figure 4
Figure 4
Scattergrams for AIT (top) and phaco-AIT (bottom) demonstrating IOP change from preoperative baseline to final measurement at 1 month (left) and at 12 months (right). There were no significant differences between single groups or between all AIT compared with all phaco-AIT (p>0.05). AIT, ab interno trabeculectomy; IOP, intraocular pressure.
Figure 5
Figure 5
Kaplan–Meier survival plots for AIT (left) and phaco-AIT (right) with success defined as a final IOP of 20% reduction from baseline without further surgery. No statistically significant difference between SG groups in AIT (p=0.70) and phaco-AIT (p=0.56). AIT, ab interno trabeculectomy; IOP, intraocular pressure; SG, Shaffer grade.

References

    1. Minckler DS, Baerveldt G, Alfaro MR, et al. . Clinical results with the Trabectome for treatment of open-angle glaucoma. Ophthalmology 2005;112:962–7.
    1. Kaplowitz K, Schuman JS, Loewen NA. Techniques and outcomes of minimally invasive trabecular ablation and bypass surgery. Br J Ophthalmol 2014;98: 579–85.
    1. Liu J, Jung J, Francis BA. Ab interno trabeculotomy: TrabectomeTM surgical treatment for open-angle glaucoma. Expert Rev Ophthalmol 2009;4:119–28.
    1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262–7.
    1. Bhargava SK, Leighton DA, Phillips CI. Early angle-closure glaucoma. Distribution of iridotrabecular contact and response to pilocarpine. Arch Ophthalmol 1973;89:369–72.
    1. Hayashi K, Hayashi H, Nakao F, et al. . Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. Ophthalmology 2000;107:698–703.
    1. Minckler D, Mosaed S, Dustin L. Trabectome (trabeculectomy-internal approach): additional experience and extended follow-up. Trans Am Ophthalmol Soc 2008;106:149–59; discussion 159–60.
    1. Stamper RL. CHAPTER 7—Clinical interpretation of gonioscopic findings. In: Stamper RL, Lieberman MF, Drake MV eds. Becker-Shaffer's Diagnosis and Therapy of the Glaucomas. 8th edn. Mosby, 2009:78–90.
    1. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing, 2014.
    1. Barbosa DTQ, Levison AL, Lin SC. Clear lens extraction in angle-closure glaucoma patients. Int J Ophthalmol 2013;6:406–8.
    1. Shin HC, Subrayan V, Tajunisah I. Changes in anterior chamber depth and intraocular pressure after phacoemulsification in eyes with occludable angles. J Cataract Refract Surg 2010;36:1289–95.
    1. Nonaka A, Kondo T, Kikuchi M, et al. . Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure. Ophthalmology 2006;113:437–41.
    1. Klein BE, Klein R, Lee KE. Incidence of age-related cataract: the Beaver Dam Eye Study. Arch Ophthalmol 1998;116:219–25.
    1. Leske MC, Wu SY, Nemesure B, et al. . Incidence and progression of lens opacities in the Barbados Eye Studies. Ophthalmology 2000;107:1267–73.
    1. Hashemi H, Khabazkhoob M, Miraftab M, et al. . The distribution of axial length, anterior chamber depth, lens thickness, and vitreous chamber depth in an adult population of Shahrud, Iran. BMC Ophthalmol 2012;12:50.
    1. Salmon JF. Presenting features of primary angle-closure glaucoma in patients of mixed ethnic background. S Afr Med J 1993;83:594–7.
    1. Kothari R, Tathe S, Gogri P, et al. . Lens-induced glaucoma: the need to spread awareness about early management of cataract among rural population. ISRN Ophthalmol 2013;2013:581727.
    1. Lee JWY, Lai JSM, Yick DWF, et al. . Retrospective case series on the long-term visual and intraocular pressure outcomes of phacomorphic glaucoma. Eye 2010;24:1675–80.
    1. Leung CKS, Chan W-M, Ko CY, et al. . Visualization of anterior chamber angle dynamics using optical coherence tomography. Ophthalmology 2005;112:980–4.
    1. Francis BA, Minckler D, Dustin L, et al. . Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: initial results. J Cataract Refract Surg 2008;34:1096–103.
    1. Nau CB, Malihi M, McLaren JW, et al. . Circadian variation of aqueous humor dynamics in older healthy adults. Invest Ophthalmol Vis Sci 2013;54:7623–9.
    1. Fellman RL, Grover DS. Episcleral venous fluid wave: intraoperative evidence for patency of the conventional outflow system. J Glaucoma 2014;23:347–50.
    1. Mansberger SL, Gordon MO, Jampel H, et al. . Reduction in intraocular pressure after cataract extraction: the Ocular Hypertension Treatment Study. Ophthalmology 2012;119:1826–31.
    1. Yang HS, Lee J, Choi S. Ocular biometric parameters associated with intraocular pressure reduction after cataract surgery in normal eyes. Am J Ophthalmol 2013;156:89–94.e1.
    1. Shingleton BJ, Pasternack JJ, Hung JW, et al. . Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma 2006;15:494–8.
    1. Poley BJ, Lindstrom RL, Samuelson TW, et al. . Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomatous eyes: evaluation of a causal relationship between the natural lens and open-angle glaucoma. J Cataract Refract Surg 2009;35:1946–55.
    1. Wang N, Chintala SK, Fini ME, et al. . Ultrasound activates the TM ELAM-1/IL-1/NF-kappaB response: a potential mechanism for intraocular pressure reduction after phacoemulsification. Invest Ophthalmol Vis Sci 2003;44:1977–81.
    1. Samuelson TW, Katz LJ, Wells JM, et al. . Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology 2011;118:459–67.
    1. Gedde SJ, Herndon LW, Brandt JD, et al. . Surgical complications in the Tube Versus Trabeculectomy Study during the first year of follow-up. Am J Ophthalmol 2007;143:23–31.
    1. Tham CCY, Leung DYL, Kwong YYY, et al. . Effects of phacoemulsification versus combined phaco-trabeculectomy on drainage angle status in primary angle closure glaucoma (PACG). J Glaucoma 2010;19:119–23.
    1. Sihota R, Gupta V, Agarwal HC. Long-term evaluation of trabeculectomy in primary open angle glaucoma and chronic primary angle closure glaucoma in an Asian population. Clin Experiment Ophthalmol 2004;32:23–8.
    1. Alsagoff Z, Aung T, Ang LP, et al. . Long-term clinical course of primary angle-closure glaucoma in an Asian population. Ophthalmology 2000;107:2300–4.
    1. Wilson MR, Mendis U, Paliwal A, et al. . Long-term follow-up of primary glaucoma surgery with Ahmed glaucoma valve implant versus trabeculectomy. Am J Ophthalmol 2003;136:464–70.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi