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Lucy Zhang, Nisha Chadha, Ji Liu; Combined trabeculotomy ab interno and endocyclophotocoagulation procedure for open angle glaucoma treatment: a case series. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6517.
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© ARVO (1962-2015); The Authors (2016-present)
While microinvasive glaucoma surgeries (MIGS) have been evaluated individually, few studies have evaluated these techniques in combination. The purpose of this study was to investigate the intraocular pressure (IOP) lowering effect of combining trabeculotomy ab interno (trabectome) and endocyclophotocoagulation (ECP) in eyes with glaucoma.
A retrospective review of combined trabectome and ECP performed at the Yale Eye Center was analyzed over 2 years. Seven eyes with primary open angle glaucoma or exfoliative glaucoma were identified. Patients were followed between one to eight months post-operatively. Five eyes were pseudophakic and underwent combined trabectome/ECP (Group 1), and 2 eyes were phakic and underwent combined trabectome/ECP along with phacoemulsification (Group 2). IOP and glaucoma medication regimen were documented pre-operatively and compared to post-operative follow up. Data was collected from post-operative day 1 (POD1), week 1 (POW1), month 1 (POM1), month 2 (POM2), and month 3 (POM3).
In our case series, the average pre-operative IOP for Group 1 was 29.6±2.1mmHg (Mean±SE) on an average of 1.4±0.5 IOP-lowering eyedrops, and for Group 2 was 22.0±3.0mmHg on 2.5±0.5 IOP-lowering eyedrops. IOP at POD1, POW1, and POM1 was 23.0±6.8, 13.0±1.1, and 19.4±1.7mmHg for Group 1 and 17.5±5.5, 14.5±3.5, and 22±4mmHg for Group 2, respectively. At POM1 there was a 34% reduction in IOP in Group 1 on 0.8±0.4 eyedrops and no reduction in Group 2 on 1.5±0.5 eyedrops. POM2 and POM3 data showed average IOP of 17.0±0.6 and 18.7±1.8mmHg in Group 1 (data available for 3 out of 5 eyes), and 18.0±6.0 and 13.5±1.5mmHg for Group 2, respectively. The IOP reduction at POM3 was 37% for Group 1 on 0.3±0.3 eyedrops and 39% for Group 2 on 2±0 eyedrops.
Our data suggests that combined trabectome and ECP in glaucoma patients may provide additional benefit for IOP control compared to either procedure alone. Addition of phacoemulsification may further increase IOP-lowering effect but this effect may be delayed. These MIGS procedures provide a promising alternative that is less invasive than trabeculectomy and tube shunt surgery yet also preserves the conjunctiva for future surgeries if needed. Longer follow up and higher powered studies are needed to evaluate combined MIGS procedures further.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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