Abstract
PurposeTo compare intraocular pressure (IOP) reduction and to develop a predictive surgery calculator based on the results between trabectome-mediated ab interno trabeculectomy in pseudophakic patients versus phacoemulsification combined with trabectome-mediated ab interno trabeculectomy in phakic patients.MethodsThis observational surgical cohort study analyzed pseudophakic patients who received trabectome-mediated ab interno trabeculectomy (AIT) or phacoemulsification combined with AIT (phaco-AIT). Follow up for less than 12 months or neovascular glaucoma led to exclusion. Missing data was imputed by generating 5 similar but non-identical datasets. Groups were matched using Coarsened Exact Matching based on age, gender, type of glaucoma, race, preoperative number of glaucoma medications and baseline intraocular pressure (IOP). Linear regression was used to examine the outcome measures consisting of IOP and medications.ResultsOf 949 cases, 587 were included consisting of 235 AIT and 352 phaco-AIT. Baseline IOP between groups was statistically significant (p≤0.01) in linear regression models and was minimized after Coarsened Exact Matching. An increment of 1 mmHg in baseline IOP was associated with a 0.73±0.03 mmHg IOP reduction. Phaco-AIT had an IOP reduction that was only 0.73±0.32 mmHg greater than that of AIT. The resulting calculator to determine IOP reduction consisted of the formula -13.54+0.73 × (phacoemulsification yes:1, no:0) + 0.73 × (baseline IOP) + 0.59 × (secondary open angle glaucoma yes:1, no:0) + 0.03 × (age) + 0.09 × (medications).ConclusionsThis predictive calculator for minimally invasive glaucoma surgery can assist clinical decision making. Only a small additional IOP reduction was observed when phacoemulsification was added to AIT. Patients with a higher baseline IOP had a greater IOP reduction.
Highlights
Cataract surgery is often associated with a moderate intraocular pressure (IOP) reduction of 1.5–3 mmHg in patient with ocular hypertension or glaucoma [1,2,3]
An increment of 1 mmHg in baseline IOP was associated with a 0.73±0.03 mmHg IOP reduction
The resulting calculator to determine IOP reduction consisted of the formula -13.54+0.73 ×
Summary
Cataract surgery is often associated with a moderate intraocular pressure (IOP) reduction of 1.5–3 mmHg in patient with ocular hypertension or glaucoma [1,2,3]. Ab interno trabeculectomy with the trabectome (Neomedix Corp; Tustin, CA), another MIGS modality, lowers IOP by plasma-mediated ionization and ablation of trabecular meshwork (TM) of up to 180° thereby increasing aqueous outflow in eyes with an intact downstream drainage system [4]. Both ab interno trabeculectomy (AIT) and phacoemulsification combined with ab interno trabeculectomy (phaco-AIT) can be used in patients with different angle opening [7] and surgical status [8,9]. The resulting calculator can help clinicians to predict the IOP reduction
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