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Carlos Francisco Navas Villar, Janet Stephany Silva Ortiz, Curt Hartleben Matkin; Outcomes of trabectome and phaco-trabectome by glaucoma severity: experience in a reference center in Mexico.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):467. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To report the results of phacoemulsification combined with trabectome and trabectome alone in patients with different types and degrees of glaucoma in a reference center in Mexico using a severity index.
A retrospective analysis of glaucoma patients who underwent trabectome or phacoemulsification plus trabectome and who had a follow-up of at least 6 months was carried. The patients were classified into four groups according to a glaucoma severity index (GSI) that considers preoperative intraocular pressure (IOP), number of glaucoma medications and degree of damage according to visual field (VF). The main result after surgery was the degree of IOP reduction and its relation to the GSI.
We reviewed 41 records, 50 eyes of 41 patients, of which 12 underwent trabectome surgery alone and 38 phacoemulsification plus trabectome. Mean age of patients was 70.7 ± 13.6 years. Twenty-two patients were male and 28 were female. Mean follow up time was 9.24 ± 3.61 months. Mean preoperative intraocular pressure was 18.5 ± 6.5mmHg. The average number of preoperative medications was 2.48 ± 1.24. Mean preoperative IOP for trabectome eyes was 2.09 ± 8.3 mmHg and 17.71 ± 5.92 mmHg for phaco-trabectome. Groups were classified as follows: GSI I (mild glaucoma) consisted of 17 eyes, GSI II (moderate) had 13 eyes, GSI III (advanced) 9 eyes and GSI IV (severe) had 11 eyes. Mean IOP reduction in Group I at six months post-operative was 2.57 ± 4.44 mmHg, in Group II mean IOP reduction was 3.66 ± 5.64 mmHg, and 3.0 ± 7.76 mmHg and 9.3 ± 9.61 mmHg in Group III and IV respectively. Pseudoexfoliation and pigmentary glaucoma had the greater IOP reduction at six months (12.0 ± 8.73 mmHg and 7.00 ± 2.82 mmHg respectively) in comparison to congenital and steroid induced glaucoma in which IOP actually increased (7.00 ± 0 mmHg and 0.5mmHg ± 2.12 respectively).
A reduction in IOP was observed in all groups. A high GSI was associated with a greater reduction in IOP and the type of glaucoma such as pseudoexfoliation and pigmentary glaucoma. This data suggests that ab interno ablation of the trabecular meshwork may be indicated for other than primary open angle glaucoma with mild to moderate damage.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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