April 2014
Volume 55, Issue 13
ARVO Annual Meeting Abstract  |   April 2014
Trabectome-Mediated Ab Interno Trabeculectomy in Highly Complex Glaucomas
Author Affiliations & Notes
  • Ralitsa Loewen
    Surgery, University of Pittsburgh, Pittsburgh, PA
  • Evan Lagouros
    Ophthalmology, University of Pittsburgh, Pittsburgh, PA
  • Nils A Loewen
    Ophthalmology, University of Pittsburgh, Pittsburgh, PA
  • Footnotes
    Commercial Relationships Ralitsa Loewen, None; Evan Lagouros, None; Nils Loewen, Neomedix (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 3176. doi:
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      Ralitsa Loewen, Evan Lagouros, Nils A Loewen; Trabectome-Mediated Ab Interno Trabeculectomy in Highly Complex Glaucomas. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3176.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: To describe outcomes of trabectome-mediated ab interno trabeculectomy in highly complex mixed mechanism glaucomas in which minimally invasive glaucoma surgery has traditionally been seen as ineffective or contraindicated.

Methods: Surgical case series describing patients with advanced forms of traumatic glaucoma, neovascular glaucoma, encircling buckle, chronic angle closure and uveitic glaucoma, some of which had failed conventional glaucoma procedures, who were successfully treated with trabectome-mediated ab interno trabeculectomy. Cases were selected from trabectome surgeries performed since July 2012 when UPMC, historically a tertiary referral center for complex glaucomas, established a focus on minimally invasive glaucoma surgeries. including trabectome ab interno trabeculectomy. Outcome measures were intraocular pressure (IOP), number of topical and systemic glaucoma medications (meds) and occurrence of vision threatening complications or vision loss.

Results: Fifteen eyes were found out of 125 with advanced complex glaucomas, 3 of which had trauma (TR), 5 with retinal detachments and buckle (RD), 3 neovascular glaucomas that were not active (NVG) and 3 with uveitis and secondary angle closure (U). Average preoperative IOP was 35±12 mmHg on 3.4±1.2 meds. Postoperative IOP was 17±7 (day 30), 12±3 (day 90), 13±3 (day 180) and 15±5 mmHg on 1.2±1.3 meds (day 360). TR had a reduction from 32±9 to 14±4 mmHg and 4 to 0 meds, RD from 31±10 to 15±4 mmHg and 4.4 to 1 meds, NVG 46±12 to 15±8 mmHg and 3.3 to 1 meds and U 30±6 to 12±5 mmHg and 3.7 to 1.3 meds. One patient in U needed CPC for further IOP reduction. No other complications or vision loss occurred.

Conclusions: Trabectome-mediated trabecular meshwork ablation, a minimally invasive glaucoma surgery modality that relies on patency of the downstream conventional outflow system, can be highly effective in complex and high risk mixed mechanism glaucomas. Serious complications are uncommon.

Keywords: 716 small incision cataract surgery • 462 clinical (human) or epidemiologic studies: outcomes/complications • 633 outflow: trabecular meshwork  

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