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Tadamichi Akagi, Hiroshi Yamada, Hanako Ohashi Ikeda, Noriyuki Unoki, Hideo Nakanishi, Nagahisa Yoshimura; Trabeculotomy ab externo Combined with Sinusotomy and with or without Removal of Schlemm’s Canal Endothelium for Primary Open Angle Glaucoma and Exfoliation Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6141.
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To evaluate the surgical outcomes of combined trabeculotomy and sinusotomy for primary open angle glaucoma (POAG) and exfoliation glaucoma (EXG) and the efficacy of Schlemm’s canal endothelium removal.
One hundred one POAG and 49 EXG patients, who underwent initial trabeculotomy combined with sinusotomy between 2006 and 2011 at Kyoto University Hospital, were retrospectively analyzed. Surgical failure was defined by the need for additional glaucoma surgery or intraocular pressure (IOP) ≥ 21 mm Hg (criterion A) and ≥ 18 mm Hg (criterion B). The follow-up period was from 12 to 72 months. Two-sample t test, chi-square test, log-rank test for Kaplan-Meier survival analysis, and Cox proportional hazards model were applied for analysis.
The preoperative IOP of POAG and EXG were 22.9 ± 5.9 and 26.7 ± 7.7 mmHg, respectively. The postoperative IOP at final visit of POAG and EXG were 15.7 ± 4.0 and 15.7 ± 3.9 mmHg, respectively. The probabilities of surgical success at 1 year after LOT for POAG and EXG were 87.1% and 85.7% for criterion A and 54.0% and 65.3% for criterion B, respectively. At 3 year LOT, the probabilities of surgical success for POAG and EXG were 79.4% and 64.6% for criterion A and 42.8% and 37.4% for criterion B, respectively. The postoperative IOP values were lower in the cases with removal of Schlemm’s canal endothelium than without, but there were no statistically significant differences in the postoperative IOP between with and without. Transient elevation of IOP levels exceeding 30 mmHg (IOP spike) was significantly less in the EXG patients with the removal of Schlemm’s canal endothelium than that without (P = 0.019), but not in the POAG patients. The Cox proportional hazards model showed that prognostic factors for surgical failure were younger age (RR = 0.9703, P < 0.013 for criterion B) and preoperative IOP (RR = 1.0865, P < 0.0001 for criterion B) in POAG and younger age (RR = 0.9097, P = 0.015 for criterion A) in EXG.
Trabeclotomy ab externo with sinusotomy appears to be effective and safe surgical modality. Combined method with removal of Schlemm’s canal endothelium is likely to have inhibitory effect against IOP spike.
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