Abstract
Abstract: :
Purpose: To examine the clinical efficacy of trabeculotomy with lake, a new surgical approach to the treatment of glaucoma. Methods:"Trabeculotomy with lake," is a combined glaucoma surgery without filtering blebs, utilizing two internal drainage routes; trabeculotomy increases aqueous outflow via Schlemm’s canal, and the lake is supposed to increase uveoscleral outflow. Trabeculotomy with lake was performed in 32 eyes (POAG 17 eyes, PE glaucoma 8 eyes, developmental glaucoma 5 eyes, secondary glaucoma 2 eyes) of 22 glaucoma patients, and the patients were prospectively followed up. The surgical procedures involve trabeculotomy ab externo with double scleral flaps and resection of the deep scleral flap followed by filling the subscleral space (lake) with viscous material. The superficial scleral flap was sutured tightly to prevent filtering bleb formation. To assess the survival of the lake, ultrasound biomicroscopy (UBM) was performed 6 months after the surgery. Results:The mean follow–up was 17.2 months (range: 2 to 48 months). The mean preoperative intraocular pressure (IOP) was 22.0 +/– 7.16 (mean +/– standard deviation) mmHg with full medications. The mean postoperative IOP was 14.3 +/– 6.0 mmHg at 1 month, 13.0 +/– 3.3 mmHg at 3 months, 12.7 +/– 2.9 mmHg at 6 months, 14.5 +/– 3.1 mmHg at 1 year, 14.0 +/– 1.4 mmHg at 2 years, 13.5 +/– 0.7 mmHg at 3 years, and 14.0 +/– 2.68 mmHg at 4 years. The success rate, defined as an IOP lower than 22 mmHg without antiglaucoma medication, was 84.4%, and that with antiglaucoma medication was 93.8%. No significant complication occurred. The UBM findings showed the presence of the lake in the successful eyes, while the lake was not detected in the unsuccessful eyes. Conclusions:The present study demonstrated that trabeculotomy with lake can produce long–term reduction in the IOP without filtering blebs. It was suggested that survival of the lake was associated with the success in this procedure.
Keywords: outflow: trabecular meshwork • outflow: ciliary muscle • aqueous