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Eri Nakano, Tadamichi Akagi, Hideo Nakanishi, Hanako Ohashi Ikeda, Satoshi Morooka, Kyoko Kumagai, Nagahisa Yoshimura; One-year Clinical Outcomes of Trabectome and Trabeculotomy for Open-angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2658.
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© ARVO (1962-2015); The Authors (2016-present)
To describe one-year clinical outcomes of Trabectome (TOM) and Trabeculotomy (TLO) for open-angle glaucoma (OAG).
We recruited 65 patients (86 eyes) who underwent TOM surgery between February 2013 and June 2014 prospectively, and 94 patients(117 eyes) who underwent TLO between April 2010 and December 2013 retrospectively. We only included OAG patients and excluded the eyes which had history of ocular surgery except for cataract surgery. All surgeries were performed by the same surgeon (TA). A 1.70 mm keratome incision was made temporally in TOM surgery and was expanded into 2.75 mm when combined with cataract surgery. In all TLO cases, surgery was performed with deep sclerectomy inferiorly to preserve intact upper conjunctiva and another keratome incision was made in case cataract surgery was combined. The intraocular pressure (IOP) was followed up for 12 months after surgery. We defined hyphema as the formation of niveau and postoperative IOP spike as 20% IOP increase from preoperative level within one week after surgery.
We finally analyzed 72 eyes with TOM (primary open-angle glaucoma (POAG): 44, pseudoexfoliation glaucoma (EXG): 22, secondary open-angle glaucoma (SG): 6) and 62 eyes with TLO (POAG: 26, EXG: 25, SG: 11). Mean preoperative IOPs were 22.2±7.4 mmHg in TOM group and 25.9±8.9 mmHg in TLO group. Mean postoperative IOPs were 14.6±3.4mmHg (TOM) and 15.5±3.9mmHg (TLO) at 3 months, 16.4±3.1mmHg (TOM) and 16.0±7.1mmHg (TLO) at 6 months, and 16.6±1.7mmHg (TOM) and 15.7±5.8mmHg (TLO) at 12 months. In both groups, the mean postoperative IOPs significantly decreased from preoperative level throughout entire postoperative periods. Adjunctive medication decreased from 3.3±0.9 to 1.4±1.1 in TOM group and from 3.1±0.9 to 1.6±1.2 in TLO group at 12 months after surgery. Postoperative IOP spikes were observed in 10 eyes (13.9%) of TOM group and 8 eyes (12.9%) of TLO group. In TOM group, postoperative IOP spike was significantly associated with postoperative hyphema (p=0.05).
The effects of lowering IOP were almost the same in TOM and TLO. In TOM group, postoperative spike was related to postoperative hyphema.
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