Trabeculotomy with Schlemm’s canal endothelium removal and deep sclerectomy

Abstract

Purpose: To evaluate the effects of trabeculotomy (TLO) combined with Schlemm’s canal endothelium removal (SER) and deep sclerectomy (DS) on surgical outcomes in adult glaucomatous eyes.

Methods: Fifty-six primary open angle glaucoma, 18 developmental glaucoma, 23 exfoliation glaucoma and 34 secondary glaucoma eyes were enrolled with at least 1 year follow-up after surgery. Fifty-three eyes underwent TLO+SER+DS (SER) and 78 eyes underwent TLO without SER (Non-SER), where SER was defined as peeling of Schlemm’s canal endothelium opening under the scleral flap. Surgical failure was defined as the need for additional glaucoma surgery or intraocular pressure (IOP) > 21 mm Hg. Surgical outcomes were compared between the 2 groups.

Results: Transient ocular hypertension (>30mmHg) was significantly less likely to occur in SER (p<0.001) compared with Non-SER. SER decreased IOP at 3 years (15.4±4.8mmHg) without significant efficacy in terms of lowered IOP compared with Non-SER (16.6±4.1mmHg). Kaplan-Meier survival analysis revealed that the success rate was significantly higher in the SER group (88.2%) than in the Non-SER group (59.2%) (P<0.001) at 3 years after surgery. The Cox proportional hazards ratio showed that no performance of SER was the factor associated with surgical failure, whereas glaucoma type and preoperative IOP were not.

Conclusions: SER at TLO has a potency to avoid transient post-operative ocular hypertension and control IOP < 21 mm Hg.