Abstract
Purpose
To compare the efficacy of ab-interno trabeculotomy with Trabectome® in mild glaucoma versus moderate/severe glaucoma along the spectrum of glaucoma disease severity.
Methods
Subjects with at least 12 months follow-up were separated into two groups based on glaucoma severity. Severity was determined based on optic nerve cup-to-disc ratio and/or automated visual field data, with cup-to-disc ratio < 0.7 and/or visual field mean deviation ≤ 6.0 dB used to define the mild group (n = 1127), and cup-to-disc ratio > 0.7 and/or visual field mean deviation > 6.0 dB used to define the moderate/severe group (n = 1071). These groups were further subdivided into patients undergoing Trabectome with cataract surgery or Trabectome alone. Mean IOP reduction, medication usage, and success rates were compared between the two groups. Success was defined as IOP reduction of 20% or more from pre-operative IOP and IOP less than 21 mmHg with no secondary surgery throughout the follow-up period.
Results
The mean post-operative IOP and success rates were similar between the groups. IOP reduction for the mild group was 26% (from pre-op IOP of 24 to 16.1 mmHg) and for the moderate/severe group was 24% (from pre-op IOP of 22.6 to 15.7 mmHg) at 12 Months. The overall rate of success at 12 months for the mild group was 86% and for the moderate/severe group was 83%.
Conclusion
Trabectome surgery maintains efficacy across the spectrum of glaucoma disease severity. This particular minimally invasive glaucoma surgery procedure can be an excellent choice for subjects with moderate/advanced glaucoma as well as for early glaucoma with or without cataract surgery and is applicable to a broad patient population.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
DeBry PW, Perkins TW, Heatley G et al (2002) Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol 120(3):297–300
Sit AJ, Khaja H (2008) Relationship between ablation arc length and IOP with Trabectome surgery. AAO Scientific Poster 102
Ting JL, Damji KF, Stiles MC et al (2012) Ab interno trabeculectomy: outcomes of exfoliation versus primary open angle glaucoma. J Cataract Refract Surg 38(2):315–323
Mosaed S, Chak G, Haider A et al (2015) Results of Trabectome surgery following failed glaucoma tube shunt implantation: cohort study. Medicine 94(30):e1045
Francis BA. (2015) Trabectome combine with phacoemulsification versus phacoemulsification alone: a prospective non-randomized controlled surgical trial. A supplement of clinical & surgical ophthalmology
Francis BA, Minckler D, Dustin L et al (2008) Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: initial results. J Cataract Refract Surg 34(7):1096–1103
Food US (2012) FDA 510 (k) Database Entry Neomedix NMX-1000 (Trabectome). (2014) Available: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K040584. (Date of access: March 27, 2017)
Mosaed S, Rhee D, Filippopoulous T et al (2010) Trabectome outcomes in adult open-angle glaucoma patients: one-year follow up. Clin Surg Ophthalmology 28(8–9):182–186
Minckler DS, Baerveldt G, Alfaro MR et al (2005) Clinical results with the Trabectome for treatment of open-angle glaucoma. Ophthalmology 112(6):962–967
Chan EW, Chiang PP, Wong TY et al (2013) Impact of glaucoma severity and laterality on vision-specific functioning: the Singapore Malay eye study. Invest Ophthalmol Vis Sci 54(2):1169–1175
Enders P, Schaub F, Adler W et al (2016) The use of Bruch’s membrane opening-based optical coherence tomography of the optic nerve head for glaucoma detection in microdiscs. Br J Ophthalmol 101(4):530–535
Susanna R Jr, Vessani RM (2009) Staging glaucoma patient: why and how? Open Ophthalmol J 17(3):59–64
Gedde SJ, Schiffman JC, Feuer WJ et al (2007) Treatment outcomes in the tube versus trabeculectomy study after one year of follow-up. Am J Ophthalmol 143(1):9–22
Tektas OY, Lutjen-Decoll E (2009) Structural changes of the trabecular meshwork in different kinds of glaucoma. Exp Eye Res 88(4):769–775
Allingham RR, Damji KF, Freedman SF, et al. (2012) Shields textbook of glaucoma. Lippincott Williams & Wilkins
Singh K, Spaeth G, Zimmerman T et al (2007) _target pressure: the glaucomatologist holy grail. Ophthalmology 7:629–630
Friedman DS, Jampel HD, Lubomski LH et al (2002) Surgical strategies for coexisting glaucoma and cataract: an evidence based update. Ophthalmology 109:1902–1915
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
This was a retrospective study and informed consent was not required.
Rights and permissions
About this article
Cite this article
Ahmed, S.F., Bhatt, A., Schmutz, M. et al. Trabectome outcomes across the spectrum of glaucoma disease severity. Graefes Arch Clin Exp Ophthalmol 256, 1703–1710 (2018). https://doi.org/10.1007/s00417-018-4023-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-018-4023-8