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Samantha XY Wang, Paween Phuchantuk, Shaheen Kavoussi, Ron A Adelman, James C Tsai, Tomas M Grippo, Ji Liu; Impact of laser trabeculoplasty and cataract surgery on ab interno trabeculectomy (Trabectome) outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3173.
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To report the impact of laser trabeculoplasty and phacoemulsification on outcomes of Trabectome.
Single-center retrospective study of 189 consecutive cases of Trabectome surgery that had 12-months of follow up. Trabectome surgeries were either Trabectome only (Tome) or combined with phacoemulsification cataract extraction and intraocular lens implantation (Tome+CE/IOL). Two groups were compared: eyes with no history of laser trabeculoplasty (NoLT) and eyes with a history of laser trabeculoplasty (LT) prior to Trabectome surgery. Outcomes included: intraocular pressure (IOP) reduction, glaucoma medication reduction, and secondary glaucoma procedures.
189 Trabectome cases qualified for analysis: 129 cases of primary open angle glaucoma (POAG), 40 cases of normal tension glaucoma (NTG), and 20 cases of pseudoexfoliation glaucoma (PXG). 172 cases were Tome+CE/IOL and 17 cases were Tome. The mean preoperative IOP was 19.2±5.6mmHg and 21.8±10.4mmHg in the NoLT (n=147) and LT groups (n=42) respectively. At 12 months, the mean IOP decrease was -4.0±6.2mmHg (16%) in the NoLT group and -4.5±9.6mmHg (15%) in the LT group. Glaucoma medication reduction did not differ between the two groups. Laser trabeculoplasty type did not affect outcomes. 4.8% of NoLT eyes and 15.2% of LT eyes required secondary glaucoma procedures (p=0.04). Applying OHTS criteria, an IOP reduction of at least 20% was achieved in 47% of NoLT eyes and 38% of LT eyes. Linear regression compared outcomes among POAG, NTG, and PXG eyes. PXG eyes with or without prior laser trabeculoplasty had significantly greater IOP reduction (-9.9±12.0mmHg, 34%) and glaucoma medication reduction (-1.5±1.4 drops, 59%) compared to NTG (-2.3±3.6mmHg, 13%, p<0.001; -0.7±1.2 drops, 36%, p=0.05) and POAG eyes (-3.8±6.4mmHg, 14%, p<0.001; -0.9±1.2 drops, 35%, p=0.03).
Trabectome was effective in decreasing IOP in eyes either with or without previous laser trabeculoplasty. Both Tome and Tome+CE/IOL resulted in a moderate decrease in IOP and a decrease in glaucoma medications. Eyes with previous laser trabeculoplasty had higher rates of secondary procedures after Trabectome. PXG eyes had the most significant reduction in IOP and glaucoma medications and may be good candidates for Trabectome.
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