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Xuejing Chen, Kevin Kaplowitz, Nils Loewen; Trabectome Results In Eyes With Low Preoperative IOP. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5931.
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To assess the utility of trabectome ab-interno trabeculotomy in eyes with low preoperative (preop) IOP of <21 mmHg. Such eyes have a gradient from the anterior chamber to collector channels that is less pronounced and may benefit less from outflow barrier removal.
We analyzed data from a prospective non-randomized trial of 558 patients who underwent trabectome surgery with or without cataract surgery. All had to have a preop IOP of <21 mmHg and 12 month follow up. Outcome measures were IOP, glaucoma medications and secondary glaucoma surgeries.
558 all trabectome cases qualified for this analysis with a collective preop IOP of 17.5±2.8 mmHg and 2.6±1.2 glaucoma medications. At 12 months, 86% of cases did not require secondary glaucoma surgery and achieved 12% reduction of IOP and 23% reduction of medications. The IOP was reduced from baseline by 12% to 15.1±3.2 mmHg (p<0.01) and glaucoma drop usage reduced by 23% to 1.8±1.3 (p<0.01). 14% required subsequent glaucoma surgeries. Applying OHTS criteria, an IOP reduction of at least 20% was achieved in 35% of patients. 73 patients with low pressure glaucoma by LoGTS definition (IOP <21 mmHg off drops) achieved a 2.5 mmHg IOP drop from 17.7±2.6 to 15.3±2.5 mmHg at 12 months (p<0.01) and only 2.7% were advanced to secondary glaucoma surgeries. 257 trabectome-only cases had a collective pre-op IOP of 18.4±2.4 mmHg and 2.7±1.3 glaucoma medications. At 12 months, 77% of these cases did not require secondary surgery and achieved a 13% IOP reduction and 20% medication reduction. The IOP was reduced from baseline to 15.1±3.2 mmHg (p<0.01) and glaucoma drop usage reduced to 1.8±1.3 (p<0.01). 14% required subsequent glaucoma surgeries. 280 combined cataract and trabectome procedures cases had a collective pre-op IOP of 16.8±2.9 mmHg and 2.4±1.1 glaucoma medications. At 12 months, 96% of these cases did not require secondary surgery and achieved 11% IOP reduction and 20% medication reduction. The IOP was reduced from baseline to 14.8±3.0 mmHg (p<0.01) and glaucoma drop usage reduced to 1.6±1.2 (p<0.01). Only 4% required subsequent glaucoma surgeries
Trabectome can be considered as a first line of incisional surgical treatment in these patients, especially in individuals who have a cataract, want to avoid riskier procedures or are intolerant to other treatment modalities.
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