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Bennett Y Hong, You Zhou, Jeffrey J Mattingly, Brittany A. Bunag, Gianmarco Vizzeri; A Novel Modified Minimally Invasive Trabeculectomy : A Preliminary Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6628.
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There is a relative dearth of data on optimizing trabeculectomy techniques. We performed a single-surgeon retrospective consecutive case series to assess outcomes and safety of a modified fornix-based trabeculectomy procedure with adjunct mitomycin C aimed at minimizing postoperative complications and interventions. Features of the procedure include a 3mm peritomy, avoidance of a peripheral iridectomy, and formation of an overlying triangular scleral flap that is secured by a single interrupted nylon suture.
All trabeculectomy (“trab”) or combined phacoemulsification-trabeculectomy (“phaco-trab”) surgeries performed by a single surgeon between 1/1/2013 and 1/1/2018 were included. Patients who did not undergo the above procedures were excluded. 459 cases met inclusion criteria, of which 69 cases were randomly selected for preliminary analysis. There were 56 trabs (81.2%) and 13 phaco-trabs (18.8%). Baseline characteristics of included cases are provided in Table 1. Descriptive statistics and the Student’s T-test were used for analysis. Primary outcomes were surgical success (IOP ≤21 mmHg or IOP reduction ≥20%) and failure (need for subsequent glaucoma surgery in the operative eye, e.g. trab, tube shunt, or cyclophotocoagulation).
Primary outcome variables, postoperative interventions, and complications are provided in Table 2. Mean IOP in mmHg was 25.04 ±9.45 at baseline, including 30 cases (43.5%) with IOP ≤21, which improved at POY1 (13.78 ±6.53, p<0.001) and POY2 (14.93 ±7.52, p<0.001). The average number of pre-operative IOP-lowering medications was 2.72 +/- 1.05 versus 1.01 +/- 1.42 at the final study visit (p<0.001). Snellen visual acuity loss of >2 lines occurred in 15.9% (POY1) and 17.1% (POY2), but the average visual acuity was unchanged from baseline (p>0.05).
Our technique showed a high success rate and is similar to other published rates of trabeculectomy (Gedde et. al, 2012; Nitin and Vinod, 2012). In addition, there was a low rate of complications including zero instances of hyphema, a shallow anterior chamber, and hypotony maculopathy. The postoperative course was less involved and in particular, there was a low rate of suture lysis. Finally, our study comprises a more heterogeneous patient mix with a larger sample size than most trab-only studies. Further analysis is warranted to validate this technique.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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