Abstract
All the 560 glaucomatous eyes of 375 Japanese subjects (181 men, 194 women; mean age ± standard deviation, 76.0 ± 13.2 years) who underwent microhook ab interno trabeculotomy (µLOT) alone (159 eyes, 28%) or combined µLOT and cataract surgery (401 eyes, 72%) performed by one surgeon at Matsue Red Cross Hospital between May 2015 and March 2018 to control intraocular pressure (IOP) were retrospectively assessed. Preoperative and postoperative IOPs, numbers of antiglaucoma medications, the logarithm of the minimum angle of resolution visual acuity (logMAR VA), anterior chamber (AC) flare, visual field mean deviation (MD), and corneal endothelial cell density (CECD) were compared up to 36 months. Surgical complications and required interventions were described. The duration of the follow-up was 405 ± 327 (range, 2–1326) days. The mean preoperative IOP (20.2 ± 7.0 mmHg) and number of antiglaucoma medications (2.8 ± 1.1) decreased to 13.9 ± 4.5 mmHg (31% reduction, p < 0.0001) and 2.5 ± 1.0 (11% reduction, p < 0.0001), respectively, at the final visit. After combined surgery, compared with preoperatively, the final VA improved 0.11 logMAR (p < 0.0001), AC flare increased 4.5 photon counts/msec (p = 0.0011), MD improved 0.6 decibel (p < 0.0001), and the CECD decreased 6% (p < 0.0001). Layered hyphema (172 eyes, 31%) and hyphema washout (26 eyes, 5%) were the most common postoperative complication and intervention, respectively. At the final visit, 379 (69%) eyes achieved successful IOP control of ≤18 mmHg and ≥20% IOP reduction, and 349 (64%) eyes achieved successful IOP control of ≤15 mmHg and ≥20% IOP reduction. Older age, steroid-induced glaucoma, developmental glaucoma, and the absence of postoperative complications were associated with lower final IOP; exfoliation glaucoma, other types of glaucoma, and higher preoperative IOP were associated with higher final IOP. µLOT has a significant IOP-lowering potential in patients with glaucoma, and improves visual function when combined with cataract surgery.
Highlights
The intraocular pressure (IOP) in adults and children with glaucoma is reduced by trabeculotomy (LOT), which alleviates the resistance to aqueous flow by cleaving the trabecular meshwork (TM) and inner walls of the Schlemm’s canal [1,2,3]
Among the 79 (14%) eyes with a history of previous cataract surgery, 47 eyes (8%) had no history of glaucoma surgery; microhook ab interno trabeculotomy (μLOT) was performed as an initial glaucoma surgery in 475 (85%) eyes. μLOT was performed as a solo procedure in 159 (28%) eyes and combined procedure in 401 (72%) eyes; half of the eyes treated with the solo procedure were pseudophakic. μLOT was performed on both the nasal and temporal sides in 512 (92%) eyes, only on the nasal side in 24 (4%) eyes, and only on the temporal side in 24 (4%) eyes
With the mixed-effects regression model, the postoperative changes in IOP were significant in the entire dataset, and in eyes treated with μLOT alone or combined μLOT
Summary
The intraocular pressure (IOP) in adults and children with glaucoma is reduced by trabeculotomy (LOT), which alleviates the resistance to aqueous flow by cleaving the trabecular meshwork (TM) and inner walls of the Schlemm’s canal [1,2,3]. The absence of a bleb in LOT reduces the likelihood of vision-threatening complications, such as a flat anterior chamber (AC), bleb leaks/infections, hypotony maculopathy, and choroidal detachment. These can develop following trabeculectomy in which antifibrotic agents are used [1,4]. Surgeons have reported using ab interno approaches with LOT techniques [7,8]. In 2015, we treated both eyes of one patient with steroid-induced glaucoma with a novel ab interno LOT procedure, which we referred to as microhook trabeculotomy (μLOT) [9] The ab externo approach has been used to perform LOT in combination with metal trabeculotomes that incise a third of the meshwork [1,2,3], or with 5-0 and 6-0 polypropylene sutures, and a microcatheter that incises the full 360 degrees of the meshwork [5,6].
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