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B. A. Francis, D. S. Minckler, J. Yeh, L. Dustin; Combined Cataract Extraction and Trabectome® Surgery (Trabeculotomy by Internal Approach) for Coexisting Cataract and Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4190.
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To report the efficacy and safety of Trabectome surgery combined with cataract extraction in open and chronic angle closure glaucoma.
This is a prospective interventional case series of consecutive patients with open angle or chronic angle closure glaucoma and cataract undergoing phacoemulsification and Trabectome procedure. The Trabectome is designed to open a direct pathway for aqueous to flow from the anterior chamber into Schlemm’s canal collector channels. Via a gonioscopic approach, bipolar cautery is applied via a tip designed to penetrate trabecular meshwork and fit into Schlemm’s canal, and vaporizes trabecular meshwork and inner wall of the canal. In angle closure patients, lysis of goniosynechiae was performed prior to the trabectome procedure. The main outcome measures include intraocular pressure, glaucoma medication use, and complications.
252 eyes of 252 consecutive study participants were included. Total mean pre-operative IOP was 19.7 mmHg ± 6.3. Mean post-op IOP was 14.9 mmHg ± 3.8 at 6 months, and 15.5 mmHg ± 3.2 at 1 year.There was a corresponding drop in glaucoma medications from a baseline of 2.65 ± 1.13 at baseline to 1.69 ± 1.18 at 6 months (-36%) and 1.55 ± 1.34 at 1 year (-42%). Subsequent secondary glaucoma procedures were required on 9 patients. The only significant complication was blood reflux in 192 (76.2%) of patients, clearing within a few days.
Combined trabeculectomy ab interno with the Trabectome and cataract extraction has provided a lowering of IOP and medications in the majority of patients with few complications.
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