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J. L. Ting, K. F. Damji, M. C. Stiles; Trabectome: Surgical Outcomes in Exfoliative Glaucoma (XFG) versus Primary Open Angle Glaucoma (POAG). Invest. Ophthalmol. Vis. Sci. 2010;51(13):618.
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To compare Trabectome outcomes in XFG versus POAG, performed alone or in combination with cataract surgery (CE-IOL).
Retrospective analysis of Trabectome alone and Trabectome CE-IOL surgeries in XFG vs POAG cases with a minimum of one year follow-up in the Trabectome Study Group Database. Outcomes included mean IOP, glaucoma medications, secondary surgeries, and complications.
For Trabectome alone, XFG (n=46) and POAG (n=381) cases had mean preoperative IOP of 28.8±8.5 and 25.7±7.6 mmHg (p<0.05), respectively. At one year, mean IOP decreased by 36% to 16.3±4.2 mmHg for XFG (n=35) and 31% to 16.4±3.8 mmHg for POAG (n=239) (p=0.9). Preoperative glaucoma medications for XFG and POAG were 2.96±1.17 and 2.80±1.30 (p=0.4), and at one year 1.89±1.47 and 2.08±1.32 (p=0.4), respectively. Secondary surgeries were required in 23.9% of XFG and 36.5% of POAG cases (p=0.09).For Trabectome CE-IOL, XFG (n=37) and POAG (n=150) had mean preoperative IOP of 19.3±6.1 and 19.6±5.5 mm Hg (p=0.77), respectively. At one year, mean IOP decreased by 23% to 13.7±3.1 mmHg for XFG (n=34) and by 17% to 15.3±3.2 mmHg for POAG (n=137) (p<0.05). Preoperative glaucoma medications for XFG and POAG were 2.43±1.09 and 2.71±1.05 (p=0.15), and at one year 1.41±1.26 and 1.65±1.34 (p=0.3), respectively. Secondary surgeries were required in 8.1% of XFG and 8.7% of POAG cases (p=0.9).Secondary surgeries were significantly higher in POAG for Trabectome alone vs Trabectome CE-IOL (p<0.05), but of borderline significance in corresponding XFG comparisons (p=0.06).In all groups, reported incidence of intraoperative blood reflux (76.1-82.9%), day 1 hypotony (2.1-2.7%), and day 1 pressure spike (2.9-10.8%) was similar. There were no reports of sustained hypotony, choroidal effusion, hemorrhage, or infection.
For Trabectome alone, IOP decreased to a similar level at one year in XFG and POAG groups, even though XFG had a significantly higher baseline IOP. In contrast, for Trabectome CE-IOL, IOP was significantly lower at one year in XFG vs POAG, even though baseline IOP was similar. Glaucoma medications decreased by at least 25% in all groups. Secondary surgeries were more frequent with Trabectome alone. Prospective interventional studies with longer follow-up are needed to confirm efficacy and safety of Trabectome surgery in XFG.Acknowledgments: Trabectome Study Group contributors.
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