Trabeculotomy With Lake

Abstract

Abstract: : Purpose: To examine the clinical efficacy of trabeculotomy with lake (a subscleral space), a new surgical approach to the treatment of glaucoma. Methods: A new combined surgical procedure, "trabeculotomy with lake," was performed in 8 eyes (POAG 5eyes, PE glaucoma 3 eyes) of 4 advanced glaucoma patients who can not keep the filtering bleb clean and safe because of their occupations such as a farmer and a swimming instructor, and the patients were prospectively followed up for 3 years. 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. Every patient was followed up more than 3 years. Results: The mean preoperative intraocular pressure (IOP) was 21.4 +/- 3.9 (mean +/- standard deviation) mmHg with full medications. The mean postoperative IOP was 12.6 +/- 4.0 mmHg at 1 month, 12.9 +/- 4.2 mmHg at 3 months, 12.4 +/- 3.0 mmHg at 6 months, 14.1+/- 3.4 mmHg at 1 year, 12.9 +/- 3.0 mmHg at 2 years, and 13.2 +/- 3.0 mmHg at 3 years. The success rate, defined as an IOP lower than 21.0 mmHg without antiglaucoma medication, was 7/8 (87.5%) for 3 years. No significant complication occurred. The UBM findings showed the presence of the lake (a subscleral space after removal of the deep scleral flap) in the successful eyes, while the lake was not detected in the unsuccessful eye. Conclusions: The present pilot study demonstrated that trabeculotomy with lake can produce a long-term reduction in the IOP without filtering bleb. It was suggested that presence of the lake was associated with the IOP lowering mechanism in this treatment.

Keywords: clinical (human) or epidemiologic studies: tre • imaging/image analysis: clinical • intraocular pressure