Abstract
Background: Circumferential trabeculotomy have evolved from ab externo to ab interno approach. Both procedures may lower IOP, but it is unclear which maybe a superior approach.Purpose: To compare the outcomes of ab interno and ab externo circumferential trabeculotomy in patients with primary open-angle glaucoma.Design: Retrospective, comparative case series.Participants: Primary open angle glaucoma patients undergoing ab interno (40 patients in Group 1) or ab externo (54 patients in Group 2) circumferential trabeculotomy, with about one half of them having prior incisional glaucoma surgery.Methods: Outcomes including intraocular pressure (IOP), glaucoma medications and surgical complications were analyzed.Main Outcome Measures: IOP, medications and surgical success defined as an IOP of ≤ 21 mmHg and a reduction of IOP ≥20% from baseline (criterion A) or IOP ≤ 18 mmHg and a reduction of IOP 20% from baseline (criterion B) with (qualified success) or without (complete success) medications.Results: At 1 year, IOP decreased by 37.1% (26.0–14.8 mmHg) in Group 1 and 39.5% (28.5–15.1 mmHg) in Group 2. Medications decreased from 3.5 in Group 1 and 3.6 in Group 2 pre-operatively to 0.6 ± 1.0 and 0.3 ± 0.6 post-operatively, respectively. Success rates did not differ significantly between groups based on criterion A (complete and qualified success: 68.7 and 81.9% in Group 1, and 75.3 and 90.4% in Group 2, respectively) or criterion B (complete and qualified success: 58.2 and 79.3%in Group 1, and 69.5 and 88.4% in Group 2, respectively). For eyes with prior filtration surgeries, the mean percent reduction of IOP (41.7 ± 32.7% in Group 1, 39.7 ± 27.8% in Group 2, P = 0.724) and the mean medication reduction (2.9 ± 1.6 in Group 1, 3.4 ± 1.0 in Group 2, P = 0.454) were not significantly different.Conclusions: Ab interno circumferential trabeculotomy achieved comparable outcomes to ab externo trabeculotomy and may be an effective surgical option for patients with primary open-angle glaucoma.
Highlights
A primary risk factor for the development and progression of primary open-angle glaucoma (POAG) is elevated intraocular pressure (IOP), which is caused by an increased resistance to aqueous outflow
This study aims to compare the efficacy and safety of ab interno circumferential microcatheter-assisted trabeculotomy vs. ab externo circumferential trabeculotomy for POAG
An IOP of ≥30 mmHg within 1 month of surgery was defined as an IOP spike [19]
Summary
A primary risk factor for the development and progression of primary open-angle glaucoma (POAG) is elevated intraocular pressure (IOP), which is caused by an increased resistance to aqueous outflow. Procedures that remove, disrupt, or bypass the trabecular meshwork and inner wall of Schlemm’s canal can facilitate physiologic outflow and lower IOP. Based on this knowledge, many canal-based procedures have been developed, including circumferential trabeculotomy [4,5,6]. Grover et al [6] introduced a conjunctival-sparing trabeculotomy through ab interno approach, gonioscopy-assisted transluminal trabeculotomy In their preliminary study, success rates of the novel procedure ranged from 0.68 to 0.9 at 1 year in eyes with open-angle glaucoma [6]. Circumferential trabeculotomy have evolved from ab externo to ab interno approach Both procedures may lower IOP, but it is unclear which maybe a superior approach. Purpose: To compare the outcomes of ab interno and ab externo circumferential trabeculotomy in patients with primary open-angle glaucoma
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