Abstract
Background: Conventional trabeculotomy (CT) is performed in an ab-externo manner with at most 120 degrees of incision area of Schlemm’s canal (SC). Recently, gonioscopy-assisted transluminal trabeculotomy (GATT), which makes possible a 360-degree incision area of SC in an ab-interno manner, is introduced. The purpose of this study was to compare surgical outcomes for CT and GATT with and without simultaneous phacoemulsification over 24 months and to identify factors associated with surgical success. Results: Patients’ baseline characteristics were not significantly different between two groups. The surgical success rate in CT and GATT with phacoemulsification groups were 40.4% and 96.6% and were significantly higher in the GATT group than in the CT group (p < 0.001). However, the surgical success rate in CT and GATT without phacoemulsification groups were 40.8% and 54.2%, and there were no significant differences between two groups without phacoemulsification (p = 0.55). Similarly, the postoperative IOP was significantly lower in the GATT group than in the CT group only in eyes with simultaneous phacoemulsification. There were no significant differences in the numbers of glaucoma medications between the two groups. Additional glaucoma surgery was needed in 13.2% and 25.9% of patients in the GATT and CT groups, respectively (p = 0.157). The multivariate logistic regression analysis revealed that the surgical success of trabeculotomy was significantly associated with combined phacoemulsification and the type of glaucoma surgery (GATT). Conclusion: Although both groups without phacoemulsification had a similar surgical success and IOP-lowering effect, GATT combined with phacoemulsification had a higher surgical success rate and a greater IOP-lowering effect compared with combined CT and phacoemulsification. Multivariate logistic regression analysis showed that the factors associated with higher surgical success at one year and two years postoperatively were the combined phacoemulsification procedure and the GATT.
Highlights
Glaucoma is the second leading cause of blindness worldwide [1]
Combined cataract extraction was performed in 43 eyes (53.8%), 13 eyes (48.1%) in the Conventional trabeculotomy (CT) group and 30 eyes (56.6%) in the gonioscopy-assisted transluminal trabeculotomy (GATT) group, and there were no significant differences between the two groups
There were no significant differences in the numbers of glaucoma medications between both CT and GATT groups with and without phacoemulsification at all postoperative points
Summary
Glaucoma is the second leading cause of blindness worldwide [1]. In Japan, the reported prevalence of all forms of glaucoma is 5.0% among individuals aged ≥40 years [2]. Trabeculectomy is very effective for reduction of IOP and is necessary for patients with advanced glaucoma. This procedure is associated with a risk of bleb infection, which is seen within five years postoperatively in 2.2% of patients who have undergone trabeculectomy [9]. The surgical success rate in CT and GATT with phacoemulsification groups were 40.4% and 96.6% and were significantly higher in the GATT group than in the CT group (p < 0.001). The multivariate logistic regression analysis revealed that the surgical success of trabeculotomy was significantly associated with combined phacoemulsification and the type of glaucoma surgery (GATT).
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