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Eriko Yasuda, Akiyasu Kanamori, Kaori Ueda, Azusa Akashi, Yukako Inoue, Yuko Yamada, Makoto Nakamura; Trabeculotomy with Schlemm’s canal endothelium removal and deep sclerectomy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2730.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effects of trabeculotomy (TLO) combined with Schlemm’s canal endothelium removal (SER) and deep sclerectomy (DS) on surgical outcomes in adult glaucomatous eyes.
Fifty-six primary open angle glaucoma, 18 developmental glaucoma, 23 exfoliation glaucoma and 34 secondary glaucoma eyes were enrolled with at least 1 year follow-up after surgery. Fifty-three eyes underwent TLO+SER+DS (SER) and 78 eyes underwent TLO without SER (Non-SER), where SER was defined as peeling of Schlemm’s canal endothelium opening under the scleral flap. Surgical failure was defined as the need for additional glaucoma surgery or intraocular pressure (IOP) > 21 mm Hg. Surgical outcomes were compared between the 2 groups.
Transient ocular hypertension (>30mmHg) was significantly less likely to occur in SER (p<0.001) compared with Non-SER. SER decreased IOP at 3 years (15.4±4.8mmHg) without significant efficacy in terms of lowered IOP compared with Non-SER (16.6±4.1mmHg). Kaplan-Meier survival analysis revealed that the success rate was significantly higher in the SER group (88.2%) than in the Non-SER group (59.2%) (P<0.001) at 3 years after surgery. The Cox proportional hazards ratio showed that no performance of SER was the factor associated with surgical failure, whereas glaucoma type and preoperative IOP were not.
SER at TLO has a potency to avoid transient post-operative ocular hypertension and control IOP < 21 mm Hg.
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