Microcatheter-Assisted Trabeculotomy Combined With Deep Sclerectomy and Trabeculectomy in Young to Middle-Aged Adults With Advanced Primary Open-Angle Glaucoma: 1-Year Result.

Hengli Zhang,Xiaowei Yan,Kexin Jiao,Yulei Geng,Guangxian Tang,Fan Li,Lihua Ma

doi:10.3389/fmed.2021.712332

Abstract

Objective: We aimed to evaluate the safety and clinical efficacy of ab externo microcatheter-assisted trabeculotomy combined with deep sclerectomy and trabeculectomy (MATT-DS-Trab) in the surgical management of advanced primary open-angle glaucoma (POAG).Methods: According to the inclusion criteria, we retrospectively collected and analyzed 37 POAG cases in advanced stage who received MATT-DS-Trab. The intraocular pressure (IOP), best corrected visual acuity (BCVA), use of anti-glaucoma drugs, shape of the filtering bleb, size of the scleral lake, complications, and the surgical success rate were recorded.Results: The mean IOP was 37.50 ± 8.11 mmHg before the operation, while it depleted to 10.08 ± 2.01 and 11.43 ± 2.07 mmHg at 1 week and 12 months after the operation, respectively (both P < 0.001 compared to preoperative IOP). From none to two kinds of anti-glaucoma drugs were used 12 months after surgery on the patients, which were significantly reduced compared with that preoperatively (P < 0.001). An L-type filtering bleb was the main form at all time points after the operation. At 12 months following surgery, an F-type filtering bleb accounted for 5.41% and no E-type filtering bleb was recorded. The length and height of the scleral lake shrunk with time, but there was no statistical significance (P > 0.05). Also, there was no correlation between the size of the scleral pool and the IOP (P > 0.05). At 12 months after the operation, the complete success rates were 94.59, 83.78, and 72.97% according to standards A (≤18 mmHg), B (≤15 mmHg), and C (≤12 mmHg), respectively. Intraoperative complications were mainly anterior chamber hemorrhage, and no complications related to the filtration bleb were observed after the operation.Conclusion: Based on multichannel mechanisms, MATT-DS-Trab is able to effectively reduce IOP in advanced POAG patients, with few serious complications and a high success rate.

Highlights

Primary open-angle glaucoma (POAG) often causes blindness
We aimed to evaluate the safety and clinical efficacy of ab externo microcatheter-assisted trabeculotomy combined with deep sclerectomy and trabeculectomy (MATT-DS-Trab) in the surgical management of advanced primary open-angle glaucoma (POAG)
The mean intraocular pressure (IOP) was 37.50 ± 8.11 mmHg before the operation, while it depleted to 10.08 ± 2.01 and 11.43 ± 2.07 mmHg at 1 week and 12 months after the operation, respectively

Summary

Introduction

Primary open-angle glaucoma (POAG) often causes blindness. Trabeculectomy is a classic operation used to treat glaucoma and is considered one of the primary surgical treatments for POAG. We incised the inner wall of the SC and the trabecular meshwork (TM) This may promote drainage of aqueous humor and reduce intraocular pressure (IOP) when combined with accurate surgical positioning. Studies have shown that trabeculotomy for POAG in adults is not as effective as in the case of congenital glaucoma in lowering the IOP [9, 10]. The investigation by Grover et al presented that circumferential ab interno trabeculotomy in adults with POAG is effective; the mean IOP ranged from 15.5 to 16.2 mmHg with 1.7 glaucoma drugs 12 months after surgery [10]. Trabeculotomy is more suited to treat patients with POAG in the early and moderate stages who have not adapted to glaucoma filtering surgery and whose IOP values do not need to be reduced to

Methods

Results

Conclusion