April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Impact of laser trabeculoplasty and cataract surgery on ab interno trabeculectomy (Trabectome) outcomes
Author Affiliations & Notes
  • Samantha XY Wang
    Yale University School of Medicine, New Haven, CT
  • Paween Phuchantuk
    Yale University School of Medicine, New Haven, CT
  • Shaheen Kavoussi
    Yale University School of Medicine, New Haven, CT
  • Ron A Adelman
    Yale University School of Medicine, New Haven, CT
  • James C Tsai
    Yale University School of Medicine, New Haven, CT
  • Tomas M Grippo
    Yale University School of Medicine, New Haven, CT
  • Ji Liu
    Yale University School of Medicine, New Haven, CT
  • Footnotes
    Commercial Relationships Samantha XY Wang, None; Paween Phuchantuk, None; Shaheen Kavoussi, None; Ron Adelman, None; James Tsai, None; Tomas Grippo, None; Ji Liu, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 3173. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To report the impact of laser trabeculoplasty and phacoemulsification on outcomes of Trabectome.

 
Methods
 

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.

 
Results
 

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).

 
Conclusions
 

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.

 
 
Subject characteristics. a=within NoLT; b=within LT. All other p-values are between group comparisons.
 
Subject characteristics. a=within NoLT; b=within LT. All other p-values are between group comparisons.
 
 
Tome vs. Tome+CE/IOL outcomes.
 
Tome vs. Tome+CE/IOL outcomes.
 
Keywords: 735 trabecular meshwork • 568 intraocular pressure • 462 clinical (human) or epidemiologic studies: outcomes/complications  
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