Intermediate outcomes of ab externo circumferential trabeculotomy and canaloplasty in POAG patients with prior incisional glaucoma surgery

Huaizhou Wang,Sarah Ziaei,Chen Xin,Ying Han,Ningli Wang,Yan Shi

doi:10.1186/s12886-020-01645-0

Abstract

BackgroundTo compare the efficacy and safety of ab externo circumferential trabeculotomy (ECT) and canaloplasty on primary open angle glaucoma (POAG) patients with failed filtering surgery and intact schlemm’s canal (SC).MethodsWe conducted a retrospective chart review of POAG patients with failed filtering surgery and intact SC, who further received ECT and canaloplasty. The primary outcome measures were intraocular pressure (IOP) and the number of topical medications at each follow-up point. The secondary outcome compared the quantified success rate at1-year follow-up between the groups.ResultsTwenty-nine eyes were recruited in the ECT group and 19 eyes in canaloplasty group. The postoperative IOP and the number of topical medications decreased significantly in both groups (p < 0.001). The IOP at 3-month and 6-monthwas significantly lower in the ECT group (p = 0.039, p = 0.001) than in the canaloplasty group. Although the IOP at 12-mon was similar between the two groups, the number of topical medications was less in the ECT group (p = 0.040). Hyphema (72.4%) and ciliary body detachment (27.6%), which mainly resolve spontaneously, were two leading complications in the ECT group. The prevalence of hyphema was higher in ECT than in canaloplasty group (p < 0.001).ConclusionFor POAG with failed filtering surgery and intact SC, canaloplasty may be safer, whereas ECT presented better IOP control.Translational Relevance: Suggestions for surgical choice for POAG with failed filtering surgery.

Highlights

To compare the efficacy and safety of ab externo circumferential trabeculotomy (ECT) and canaloplasty on primary open angle glaucoma (POAG) patients with failed filtering surgery and intact schlemm’s canal (SC)
A retrospective chart review was performed for all POAG patients with failed filtering surgery who received canaloplasty or ECT procedures to further control intraocular pressure (IOP) in the glaucoma department of Beijing Tongren Hospital between Feb 1st, 2014 and Dec 31st, 2016
There is no significant difference between the two groups in either the number of prior surgeries

Summary

Introduction

To compare the efficacy and safety of ab externo circumferential trabeculotomy (ECT) and canaloplasty on primary open angle glaucoma (POAG) patients with failed filtering surgery and intact schlemm’s canal (SC). Glaucoma is the leading cause of irreversible blindness worldwide and it is estimated that 65.5 millions of population will involve in primary open angle glaucoma (POAG) in 2020 [1]. Surgical intervention is needed when patients fail in conservative treatment. Filtering surgery, such as trabeculectomy, is one commonly performed approach. The fistula is involved in postoperative complications. Eventual formation of scar, blocking the fistula, leads to the failure of the surgery [2, 3]. It was reported that the failure rate of glaucoma filtering surgery reached 46.9% by postoperative 5-year follow-up and was even higher in patients with prior failed filtering surgery [4]

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Discussion

Conclusion