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wenjun bao, Hailong Huang, Kazuhide Kawase, Akira Sawada, Tetsuya Yamamoto; Long-term postoperative outcome of trabeculotomy and trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4945. doi: https://doi.org/.
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To compare the long-term outcome of trabeculotomy with that of trabeculectomy.
Open angle glaucoma cases who fulfilled the following selection criteria were selected from our patient records: trabeculotomy or trabeculectomy performed as a stand-alone surgery at our hospital during the period from 2004 to 2010, follow-up period at least 6 years, and mean deviation (MD: HFA C30-2 program C30-2) ≥-15dB. Trabeculectomy cases were matched with those with trabeculotomy in age and preoperative intraocular pressure (IOP). The Kaplan-Meier analysis was employed to calculate the IOP control. Mean postoperative IOP, final medication score and postoperative MD slope (dB / year) were analyzed.
Thirty-four eyes of 30 patients and 30 eyes of 24 patients were selected in the trabeculotomy group and the matched trabeculectomy group, respectively. The Kaplan-Meier analysis estimated that the probability of successful IOP control was 55.8 ± 10.2% and 79.6 ± 7.5% (cumulative probability ± standard error) at 12-year follow-up for trabeculotomy and trabeculectomy, respectively, when surgical failure was defined as IOP≥ 21 mmHg with/without medications; it was 32.1 ± 8.1% and 61.1 ± 9.5% when defined as IOP≥16 mmHg (p=0.04: log-rank test). The mean postoperative IOP and the final medication score were significantly worse in the trabeculotomy group (p<0.001). The final postoperative visual field showed significant progression in both groups in HFA C30-2 (p=0.002 and 0.009 for trabeculotomy and trabeculectomy, respectively, Wilcoxon signed rank test). Central 10-2, however, showed significant progression in the trabeculotomy group only (p= 0.001 and 0.06 for trabeculotomy and trabeculectomy, respectively, Wilcoxon signed rank test). There was no relationship between postoperative mean IOP and postoperative MD slope in both groups.
Trabeculectomy can maintain the IOP less than 16mmHg for up to 12 years in significantly more cases as compared with trabeculotomy. Trabeculectomy keeps the central visual filed, as well. This study suggests that trabeculectomy attains better IOP control and more stabilized central visual field than does trabeculotomy for long time.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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